|
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 |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BANDING
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
4494715
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$757.54 |
| Max. Negotiated Rate |
$4,665.56 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| 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 |
$819.38
|
| 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 |
$463.80
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| 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 |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| 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 |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$1,004.90
|
| 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 |
$850.30
|
| Rate for Payer: Wellcare Medicare |
$1,166.39
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BANDING
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
4494715
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$757.54 |
| Max. Negotiated Rate |
$1,422.32 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$927.60
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$2,098.00
|
|
| Hospital Charge Code |
2975832
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$587.44 |
| Max. Negotiated Rate |
$8,392.00 |
| Rate for Payer: Aetna Commercial |
$1,888.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,804.28
|
| Rate for Payer: Aetna Managed Medicare |
$587.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,363.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,049.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,007.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,111.94
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$1,930.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,174.04
|
| Rate for Payer: Health EOS Commercial |
$1,867.22
|
| Rate for Payer: HFN Commercial |
$1,930.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,573.50
|
| Rate for Payer: Multiplan Commercial |
$1,678.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,258.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,930.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,028.02
|
| Rate for Payer: Quartz Commercial |
$1,363.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,258.80
|
| Rate for Payer: The Alliance Commercial |
$8,392.00
|
| Rate for Payer: WEA Trust Commercial |
$1,153.90
|
| Rate for Payer: WPS Commercial |
$1,553.99
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$2,098.00
|
|
| Hospital Charge Code |
2975832
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,028.02 |
| Max. Negotiated Rate |
$1,930.16 |
| Rate for Payer: Aetna Commercial |
$1,888.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,804.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,111.94
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$1,930.16
|
| Rate for Payer: Health EOS Commercial |
$1,867.22
|
| Rate for Payer: HFN Commercial |
$1,930.16
|
| Rate for Payer: Multiplan Commercial |
$1,678.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,258.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,930.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,028.02
|
| Rate for Payer: Quartz Commercial |
$1,258.80
|
| Rate for Payer: WEA Trust Commercial |
$1,153.90
|
| Rate for Payer: WPS Commercial |
$1,553.99
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BIOPSY AND POLYPECTOMY
|
Facility
|
OP
|
$4,454.00
|
|
| Hospital Charge Code |
2975833
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,247.12 |
| Max. Negotiated Rate |
$17,816.00 |
| Rate for Payer: Aetna Commercial |
$4,008.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,247.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,895.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,227.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,137.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.62
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$4,097.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,492.46
|
| Rate for Payer: Health EOS Commercial |
$3,964.06
|
| Rate for Payer: HFN Commercial |
$4,097.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,340.50
|
| Rate for Payer: Multiplan Commercial |
$3,563.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,672.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.46
|
| Rate for Payer: Quartz Commercial |
$2,895.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,672.40
|
| Rate for Payer: The Alliance Commercial |
$17,816.00
|
| Rate for Payer: WEA Trust Commercial |
$2,449.70
|
| Rate for Payer: WPS Commercial |
$3,299.08
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BIOPSY AND POLYPECTOMY
|
Facility
|
IP
|
$4,454.00
|
|
| Hospital Charge Code |
2975833
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,182.46 |
| Max. Negotiated Rate |
$4,097.68 |
| Rate for Payer: Aetna Commercial |
$4,008.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.62
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$4,097.68
|
| Rate for Payer: Health EOS Commercial |
$3,964.06
|
| Rate for Payer: HFN Commercial |
$4,097.68
|
| Rate for Payer: Multiplan Commercial |
$3,563.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,672.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.46
|
| Rate for Payer: Quartz Commercial |
$2,672.40
|
| Rate for Payer: WEA Trust Commercial |
$2,449.70
|
| Rate for Payer: WPS Commercial |
$3,299.08
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH POLYPECTOMY
|
Facility
|
IP
|
$3,389.00
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
2960560
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,660.61 |
| Max. Negotiated Rate |
$3,117.88 |
| Rate for Payer: Aetna Commercial |
$3,050.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,914.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,796.17
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,117.88
|
| Rate for Payer: Health EOS Commercial |
$3,016.21
|
| Rate for Payer: HFN Commercial |
$3,117.88
|
| Rate for Payer: Multiplan Commercial |
$2,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,033.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,117.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.61
|
| Rate for Payer: Quartz Commercial |
$2,033.40
|
| Rate for Payer: WEA Trust Commercial |
$1,863.95
|
| Rate for Payer: WPS Commercial |
$2,510.23
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH POLYPECTOMY
|
Facility
|
OP
|
$3,389.00
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
2960560
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,166.39 |
| Max. Negotiated Rate |
$4,665.56 |
| Rate for Payer: Aetna Commercial |
$3,050.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,914.54
|
| 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 |
$1,796.17
|
| 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 |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,117.88
|
| 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 |
$3,016.21
|
| Rate for Payer: HFN Commercial |
$3,117.88
|
| 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 |
$2,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,117.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.61
|
| Rate for Payer: Quartz Commercial |
$2,202.85
|
| 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 |
$1,863.95
|
| Rate for Payer: Wellcare Medicare |
$1,166.39
|
| Rate for Payer: WPS Commercial |
$2,510.23
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH STENT PLACEMENT
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
4494716
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$757.54 |
| Max. Negotiated Rate |
$1,422.32 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$927.60
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH STENT PLACEMENT
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
4494716
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$757.54 |
| Max. Negotiated Rate |
$22,532.68 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,633.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,633.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,633.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,633.17
|
| 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 |
$1,422.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,633.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,633.17
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,955.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,633.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,633.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,633.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,633.17
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,449.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$1,004.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,633.17
|
| Rate for Payer: The Alliance Commercial |
$22,532.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,633.17
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: Wellcare Medicare |
$5,633.17
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
Flexor 6Fr 45cm ANL1
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 6Fr 45cm ANL1
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 6Fr 45cm ANL1
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 6Fr 45cm ANL2
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 6Fr 45cm ANL2
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 6Fr 45cm ANL2
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 6Fr 45cm ANL3
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 6Fr 45cm ANL3
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 6Fr 45cm ANL3
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 6Fr 90cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 6Fr 90cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 6Fr 90cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 7Fr 45cm ANL0
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 7Fr 45cm ANL0
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
