|
Flunitrazepam & Metabolites, Quant, Urine
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3907355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.18 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: Aetna Commercial |
$299.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Aetna Managed Medicare |
$93.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.38
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$306.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.24
|
| Rate for Payer: Health EOS Commercial |
$296.19
|
| Rate for Payer: HFN Commercial |
$306.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: NAPHCARE Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$306.18
|
| Rate for Payer: Quartz Beloit One Network |
$163.07
|
| Rate for Payer: Quartz Commercial |
$216.32
|
| Rate for Payer: Quartz Medicare Advantage |
$199.68
|
| Rate for Payer: The Alliance Commercial |
$166.40
|
| Rate for Payer: United Healthcare PPO |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
|
Fluorescent Treponemal Antibody-Absorption
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
977953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Fluorescent Treponemal Antibody-Absorption
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
977953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$149.19 |
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$149.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$142.91
|
| Rate for Payer: HFN Commercial |
$149.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$149.19
|
| Rate for Payer: Quartz Beloit One Network |
$69.10
|
| Rate for Payer: Quartz Commercial |
$89.51
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$54.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$60.59
|
|
|
Fluorescent Treponemal Antibody-Absorption
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
977953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.86
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$102.08
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$55.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: United Healthcare PPO |
$117.78
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: Wellcare Medicare |
$13.77
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Fluorine-18 FDG
|
Facility
|
OP
|
$2,427.00
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
1486820
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$706.74 |
| Max. Negotiated Rate |
$2,322.15 |
| Rate for Payer: Aetna Commercial |
$2,271.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,170.71
|
| Rate for Payer: Aetna Managed Medicare |
$706.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,640.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,262.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,211.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,337.76
|
| Rate for Payer: Cash Price |
$728.10
|
| Rate for Payer: Cigna Commercial |
$2,322.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,412.51
|
| Rate for Payer: Health EOS Commercial |
$2,246.43
|
| Rate for Payer: HFN Commercial |
$2,322.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,893.06
|
| Rate for Payer: Multiplan Commercial |
$2,019.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,514.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,322.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,236.80
|
| Rate for Payer: Quartz Commercial |
$1,640.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,514.45
|
| Rate for Payer: The Alliance Commercial |
$1,262.04
|
| Rate for Payer: WEA Trust Commercial |
$1,388.24
|
| Rate for Payer: WPS Commercial |
$1,869.52
|
|
|
Fluorine-18 FDG
|
Professional
|
Both
|
$2,427.00
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
1486820
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$374.40 |
| Max. Negotiated Rate |
$2,397.88 |
| Rate for Payer: Aetna Commercial |
$2,397.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,170.71
|
| Rate for Payer: Cash Price |
$728.10
|
| Rate for Payer: Cash Price |
$728.10
|
| Rate for Payer: Cigna Commercial |
$2,397.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$374.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,514.45
|
| Rate for Payer: Health EOS Commercial |
$2,296.91
|
| Rate for Payer: HFN Commercial |
$2,397.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$486.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$486.19
|
| Rate for Payer: Multiplan Commercial |
$2,019.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,397.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.60
|
| Rate for Payer: Quartz Commercial |
$1,438.73
|
| Rate for Payer: The Alliance Commercial |
$1,262.04
|
| Rate for Payer: United Healthcare Medicaid |
$374.40
|
| Rate for Payer: WEA Trust Commercial |
$1,388.24
|
| Rate for Payer: WPS Commercial |
$1,869.52
|
|
|
Fluorine-18 FDG
|
Facility
|
IP
|
$2,427.00
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
1486820
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,236.80 |
| Max. Negotiated Rate |
$2,322.15 |
| Rate for Payer: Aetna Commercial |
$2,271.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,170.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,337.76
|
| Rate for Payer: Cash Price |
$728.10
|
| Rate for Payer: Cigna Commercial |
$2,322.15
|
| Rate for Payer: Health EOS Commercial |
$2,246.43
|
| Rate for Payer: HFN Commercial |
$2,322.15
|
| Rate for Payer: Multiplan Commercial |
$2,019.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,322.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,236.80
|
| Rate for Payer: Quartz Commercial |
$1,514.45
|
| Rate for Payer: WEA Trust Commercial |
$1,388.24
|
| Rate for Payer: WPS Commercial |
$1,869.52
|
|
|
Fluoro Guidance Needle Loc Spine 77003
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
6180118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.90 |
| Max. Negotiated Rate |
$520.68 |
| Rate for Payer: Aetna Commercial |
$520.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$471.35
|
| Rate for Payer: Aetna Managed Medicare |
$103.90
|
| Rate for Payer: Anthem Medicare Advantage |
$103.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$103.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$103.90
|
| Rate for Payer: Cash Price |
$158.10
|
| Rate for Payer: Cash Price |
$158.10
|
| Rate for Payer: Cash Price |
$158.10
|
| Rate for Payer: Cigna Commercial |
$520.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$274.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.90
|
| Rate for Payer: Health EOS Commercial |
$498.75
|
| Rate for Payer: HFN Commercial |
$520.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$103.90
|
| Rate for Payer: Multiplan Commercial |
$438.46
|
| Rate for Payer: NAPHCARE Commercial |
$155.84
|
| Rate for Payer: Preferred Network Access Commercial |
$520.68
|
| Rate for Payer: Quartz Beloit One Network |
$241.16
|
| Rate for Payer: Quartz Commercial |
$312.41
|
| Rate for Payer: Quartz Medicare Advantage |
$103.90
|
| Rate for Payer: The Alliance Commercial |
$394.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.90
|
| Rate for Payer: WEA Trust Commercial |
$301.44
|
| Rate for Payer: WPS Commercial |
$519.48
|
|
|
Fluoro Guidance Needle Loc Spine 7700326
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
CPT 77003 26
|
| Hospital Charge Code |
5313664
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$519.69 |
| Rate for Payer: Aetna Commercial |
$519.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Aetna Managed Medicare |
$28.25
|
| Rate for Payer: Anthem Medicare Advantage |
$28.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.25
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$519.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.25
|
| Rate for Payer: Health EOS Commercial |
$497.81
|
| Rate for Payer: HFN Commercial |
$519.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.25
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: NAPHCARE Commercial |
$42.37
|
| Rate for Payer: Preferred Network Access Commercial |
$519.69
|
| Rate for Payer: Quartz Beloit One Network |
$240.70
|
| Rate for Payer: Quartz Commercial |
$311.81
|
| Rate for Payer: Quartz Medicare Advantage |
$28.25
|
| Rate for Payer: The Alliance Commercial |
$107.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.25
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$141.23
|
|
|
Fluoro Guidance Spine Inj
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
3072751
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.90 |
| Max. Negotiated Rate |
$835.85 |
| Rate for Payer: Aetna Commercial |
$835.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$756.66
|
| Rate for Payer: Aetna Managed Medicare |
$103.90
|
| Rate for Payer: Anthem Medicare Advantage |
$103.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$103.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$103.90
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$835.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$439.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.90
|
| Rate for Payer: Health EOS Commercial |
$800.65
|
| Rate for Payer: HFN Commercial |
$835.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$103.90
|
| Rate for Payer: Multiplan Commercial |
$703.87
|
| Rate for Payer: NAPHCARE Commercial |
$155.84
|
| Rate for Payer: Preferred Network Access Commercial |
$835.85
|
| Rate for Payer: Quartz Beloit One Network |
$387.13
|
| Rate for Payer: Quartz Commercial |
$501.51
|
| Rate for Payer: Quartz Medicare Advantage |
$103.90
|
| Rate for Payer: The Alliance Commercial |
$394.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.90
|
| Rate for Payer: WEA Trust Commercial |
$483.91
|
| Rate for Payer: WPS Commercial |
$519.48
|
|
|
Fluoro Guidance Spine Inj
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
3072751
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.36 |
| Max. Negotiated Rate |
$809.45 |
| Rate for Payer: Aetna Commercial |
$791.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$756.66
|
| Rate for Payer: Aetna Managed Medicare |
$246.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$571.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$439.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$422.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.32
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$809.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$492.37
|
| Rate for Payer: Health EOS Commercial |
$783.06
|
| Rate for Payer: HFN Commercial |
$809.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$659.88
|
| Rate for Payer: Multiplan Commercial |
$703.87
|
| Rate for Payer: NAPHCARE Commercial |
$527.90
|
| Rate for Payer: Preferred Network Access Commercial |
$809.45
|
| Rate for Payer: Quartz Beloit One Network |
$431.12
|
| Rate for Payer: Quartz Commercial |
$571.90
|
| Rate for Payer: Quartz Medicare Advantage |
$527.90
|
| Rate for Payer: The Alliance Commercial |
$415.58
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$483.91
|
| Rate for Payer: WPS Commercial |
$651.67
|
|
|
Fluoro Guidance Spine Inj
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
3072751
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$431.12 |
| Max. Negotiated Rate |
$809.45 |
| Rate for Payer: Aetna Commercial |
$791.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$756.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.32
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$809.45
|
| Rate for Payer: Health EOS Commercial |
$783.06
|
| Rate for Payer: HFN Commercial |
$809.45
|
| Rate for Payer: Multiplan Commercial |
$703.87
|
| Rate for Payer: Preferred Network Access Commercial |
$809.45
|
| Rate for Payer: Quartz Beloit One Network |
$431.12
|
| Rate for Payer: Quartz Commercial |
$527.90
|
| Rate for Payer: WEA Trust Commercial |
$483.91
|
| Rate for Payer: WPS Commercial |
$651.67
|
|
|
FLUOROGUIDE FOR VEIN DEVICE 7700126
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 77001 26
|
| Hospital Charge Code |
3015313
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$239.10 |
| Rate for Payer: Aetna Commercial |
$239.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$239.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$229.03
|
| Rate for Payer: HFN Commercial |
$239.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$25.91
|
| Rate for Payer: Preferred Network Access Commercial |
$239.10
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$143.46
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$65.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$86.37
|
|
|
Fluoroscope Exam 76000
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
3303478
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$217.31 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
Fluoroscope Exam 7600026
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 76000 26
|
| Hospital Charge Code |
3137543
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$134.37 |
| Rate for Payer: Aetna Commercial |
$134.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$15.07
|
| Rate for Payer: Anthem Medicare Advantage |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.07
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$134.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.07
|
| Rate for Payer: Health EOS Commercial |
$128.71
|
| Rate for Payer: HFN Commercial |
$134.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.07
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$22.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.37
|
| Rate for Payer: Quartz Beloit One Network |
$62.23
|
| Rate for Payer: Quartz Commercial |
$80.62
|
| Rate for Payer: Quartz Medicare Advantage |
$15.07
|
| Rate for Payer: The Alliance Commercial |
$57.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.07
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$75.35
|
|
|
FLUORO W/JOINT INJECTION ONLY
|
Facility
|
OP
|
$1,485.00
|
|
| Hospital Charge Code |
5294612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$432.43 |
| Max. Negotiated Rate |
$1,420.85 |
| Rate for Payer: Aetna Commercial |
$1,389.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,328.18
|
| Rate for Payer: Aetna Managed Medicare |
$432.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,003.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$772.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$741.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$818.53
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$1,420.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$864.27
|
| Rate for Payer: Health EOS Commercial |
$1,374.52
|
| Rate for Payer: HFN Commercial |
$1,420.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,158.30
|
| Rate for Payer: Multiplan Commercial |
$1,235.52
|
| Rate for Payer: NAPHCARE Commercial |
$926.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,420.85
|
| Rate for Payer: Quartz Beloit One Network |
$756.76
|
| Rate for Payer: Quartz Commercial |
$1,003.86
|
| Rate for Payer: Quartz Medicare Advantage |
$926.64
|
| Rate for Payer: The Alliance Commercial |
$772.20
|
| Rate for Payer: WEA Trust Commercial |
$849.42
|
| Rate for Payer: WPS Commercial |
$1,143.90
|
|
|
FLUORO W/JOINT INJECTION ONLY
|
Facility
|
IP
|
$1,485.00
|
|
| Hospital Charge Code |
5294612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$756.76 |
| Max. Negotiated Rate |
$1,420.85 |
| Rate for Payer: Aetna Commercial |
$1,389.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,328.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$818.53
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$1,420.85
|
| Rate for Payer: Health EOS Commercial |
$1,374.52
|
| Rate for Payer: HFN Commercial |
$1,420.85
|
| Rate for Payer: Multiplan Commercial |
$1,235.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,420.85
|
| Rate for Payer: Quartz Beloit One Network |
$756.76
|
| Rate for Payer: Quartz Commercial |
$926.64
|
| Rate for Payer: WEA Trust Commercial |
$849.42
|
| Rate for Payer: WPS Commercial |
$1,143.90
|
|
|
Fluoxetine Level
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
978117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.04 |
| Max. Negotiated Rate |
$506.15 |
| Rate for Payer: Aetna Commercial |
$495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.14
|
| Rate for Payer: Aetna Managed Medicare |
$154.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$357.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.58
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$506.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.88
|
| Rate for Payer: Health EOS Commercial |
$489.64
|
| Rate for Payer: HFN Commercial |
$506.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$412.62
|
| Rate for Payer: Multiplan Commercial |
$440.13
|
| Rate for Payer: NAPHCARE Commercial |
$330.10
|
| Rate for Payer: Preferred Network Access Commercial |
$506.15
|
| Rate for Payer: Quartz Beloit One Network |
$269.58
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: Quartz Medicare Advantage |
$330.10
|
| Rate for Payer: The Alliance Commercial |
$275.08
|
| Rate for Payer: United Healthcare PPO |
$412.62
|
| Rate for Payer: WEA Trust Commercial |
$302.59
|
| Rate for Payer: WPS Commercial |
$407.49
|
|
|
Fluoxetine Level
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
978117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$522.65 |
| Rate for Payer: Aetna Commercial |
$522.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.14
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$522.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$500.65
|
| Rate for Payer: HFN Commercial |
$522.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$440.13
|
| Rate for Payer: Preferred Network Access Commercial |
$522.65
|
| Rate for Payer: Quartz Beloit One Network |
$242.07
|
| Rate for Payer: Quartz Commercial |
$313.59
|
| Rate for Payer: The Alliance Commercial |
$275.08
|
| Rate for Payer: WEA Trust Commercial |
$302.59
|
| Rate for Payer: WPS Commercial |
$407.49
|
|
|
Fluoxetine Level
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
978117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$269.58 |
| Max. Negotiated Rate |
$506.15 |
| Rate for Payer: Aetna Commercial |
$495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.58
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$506.15
|
| Rate for Payer: Health EOS Commercial |
$489.64
|
| Rate for Payer: HFN Commercial |
$506.15
|
| Rate for Payer: Multiplan Commercial |
$440.13
|
| Rate for Payer: Preferred Network Access Commercial |
$506.15
|
| Rate for Payer: Quartz Beloit One Network |
$269.58
|
| Rate for Payer: Quartz Commercial |
$330.10
|
| Rate for Payer: WEA Trust Commercial |
$302.59
|
| Rate for Payer: WPS Commercial |
$407.49
|
|
|
Fluphenazine Level
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
5812132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$77.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.48
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.98
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$165.98
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: United Healthcare PPO |
$207.48
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Fluphenazine Level
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
5812132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$262.81 |
| Rate for Payer: Aetna Commercial |
$262.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$262.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.98
|
| Rate for Payer: Health EOS Commercial |
$251.74
|
| Rate for Payer: HFN Commercial |
$262.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$262.81
|
| Rate for Payer: Quartz Beloit One Network |
$121.72
|
| Rate for Payer: Quartz Commercial |
$157.68
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Fluphenazine Level
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
5812132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
FLUTED TOOL MIDAS REX 1MM BALL 75BA10L
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
3495518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
FLUTED TOOL MIDAS REX 1MM BALL 75BA10L
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
3495518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
