|
IgVh Nucleic Acid Separation
|
Professional
|
Both
|
$151.00
|
|
| Hospital Charge Code |
2776818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.10 |
| Max. Negotiated Rate |
$149.19 |
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| 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 |
$94.22
|
| Rate for Payer: Health EOS Commercial |
$142.91
|
| Rate for Payer: HFN Commercial |
$149.19
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| 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: The Alliance Commercial |
$78.52
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
IgVh Nucleic Acid Separation
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2776818
|
|
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
|
|
|
IIBD Serology 7 Prom
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2776819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$269.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$266.57
|
| Rate for Payer: HFN Commercial |
$275.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$275.56
|
| Rate for Payer: Quartz Beloit One Network |
$146.76
|
| Rate for Payer: Quartz Commercial |
$194.69
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$224.64
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$221.85
|
|
|
IIBD Serology 7 Prom
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2776819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$601.97 |
| Rate for Payer: Aetna Commercial |
$284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Aetna Managed Medicare |
$136.81
|
| Rate for Payer: Anthem Commercial |
$34.77
|
| Rate for Payer: Anthem Medicare Advantage |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.81
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$284.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$149.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.81
|
| Rate for Payer: Health EOS Commercial |
$272.56
|
| Rate for Payer: HFN Commercial |
$284.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.81
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: NAPHCARE Commercial |
$205.22
|
| Rate for Payer: Preferred Network Access Commercial |
$284.54
|
| Rate for Payer: Quartz Beloit One Network |
$131.79
|
| Rate for Payer: Quartz Commercial |
$170.73
|
| Rate for Payer: Quartz Medicare Advantage |
$136.81
|
| Rate for Payer: The Alliance Commercial |
$540.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.81
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: WPS Commercial |
$601.97
|
|
|
IIBD Serology 7 Prom
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2776819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$275.56 |
| Rate for Payer: Aetna Commercial |
$269.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.75
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: Health EOS Commercial |
$266.57
|
| Rate for Payer: HFN Commercial |
$275.56
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: Preferred Network Access Commercial |
$275.56
|
| Rate for Payer: Quartz Beloit One Network |
$146.76
|
| Rate for Payer: Quartz Commercial |
$179.71
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: WPS Commercial |
$221.85
|
|
|
ILEO CONDUIT
|
Facility
|
OP
|
$7,912.00
|
|
| Hospital Charge Code |
2960145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,303.97 |
| Max. Negotiated Rate |
$7,570.20 |
| Rate for Payer: Aetna Commercial |
$7,405.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,303.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,348.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,114.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,949.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,361.09
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,570.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,604.78
|
| Rate for Payer: Health EOS Commercial |
$7,323.35
|
| Rate for Payer: HFN Commercial |
$7,570.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$6,582.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,937.09
|
| Rate for Payer: Preferred Network Access Commercial |
$7,570.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.96
|
| Rate for Payer: Quartz Commercial |
$5,348.51
|
| Rate for Payer: Quartz Medicare Advantage |
$4,937.09
|
| Rate for Payer: The Alliance Commercial |
$4,114.24
|
| Rate for Payer: WEA Trust Commercial |
$4,525.66
|
| Rate for Payer: WPS Commercial |
$6,094.61
|
|
|
ILEO CONDUIT
|
Facility
|
IP
|
$7,912.00
|
|
| Hospital Charge Code |
2960145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,031.96 |
| Max. Negotiated Rate |
$7,570.20 |
| Rate for Payer: Aetna Commercial |
$7,405.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,361.09
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,570.20
|
| Rate for Payer: Health EOS Commercial |
$7,323.35
|
| Rate for Payer: HFN Commercial |
$7,570.20
|
| Rate for Payer: Multiplan Commercial |
$6,582.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,570.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.96
|
| Rate for Payer: Quartz Commercial |
$4,937.09
|
| Rate for Payer: WEA Trust Commercial |
$4,525.66
|
| Rate for Payer: WPS Commercial |
$6,094.61
|
|
|
ILEO FEMORAL BYPASS GRAFT
|
Facility
|
IP
|
$16,069.00
|
|
| Hospital Charge Code |
2960146
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,188.76 |
| Max. Negotiated Rate |
$15,374.82 |
| Rate for Payer: Aetna Commercial |
$15,040.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,372.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,857.23
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$15,374.82
|
| Rate for Payer: Health EOS Commercial |
$14,873.47
|
| Rate for Payer: HFN Commercial |
$15,374.82
|
| Rate for Payer: Multiplan Commercial |
$13,369.41
|
| Rate for Payer: Preferred Network Access Commercial |
$15,374.82
|
| Rate for Payer: Quartz Beloit One Network |
$8,188.76
|
| Rate for Payer: Quartz Commercial |
$10,027.06
|
| Rate for Payer: WEA Trust Commercial |
$9,191.47
|
| Rate for Payer: WPS Commercial |
$12,377.95
|
|
|
ILEO FEMORAL BYPASS GRAFT
|
Facility
|
OP
|
$16,069.00
|
|
| Hospital Charge Code |
2960146
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,679.29 |
| Max. Negotiated Rate |
$15,374.82 |
| Rate for Payer: Aetna Commercial |
$15,040.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,372.11
|
| Rate for Payer: Aetna Managed Medicare |
$4,679.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,862.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,355.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,021.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,857.23
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$15,374.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,352.16
|
| Rate for Payer: Health EOS Commercial |
$14,873.47
|
| Rate for Payer: HFN Commercial |
$15,374.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,533.82
|
| Rate for Payer: Multiplan Commercial |
$13,369.41
|
| Rate for Payer: NAPHCARE Commercial |
$10,027.06
|
| Rate for Payer: Preferred Network Access Commercial |
$15,374.82
|
| Rate for Payer: Quartz Beloit One Network |
$8,188.76
|
| Rate for Payer: Quartz Commercial |
$10,862.64
|
| Rate for Payer: Quartz Medicare Advantage |
$10,027.06
|
| Rate for Payer: The Alliance Commercial |
$8,355.88
|
| Rate for Payer: WEA Trust Commercial |
$9,191.47
|
| Rate for Payer: WPS Commercial |
$12,377.95
|
|
|
ILEOSCOPY THROUGH STOMA WITH BALLOON DILATION
|
Facility
|
IP
|
$4,569.00
|
|
|
Service Code
|
CPT 44381
|
| Hospital Charge Code |
4494796
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,328.36 |
| Max. Negotiated Rate |
$4,371.62 |
| Rate for Payer: Aetna Commercial |
$4,276.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,086.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,518.43
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cigna Commercial |
$4,371.62
|
| Rate for Payer: Health EOS Commercial |
$4,229.07
|
| Rate for Payer: HFN Commercial |
$4,371.62
|
| Rate for Payer: Multiplan Commercial |
$3,801.41
|
| Rate for Payer: Preferred Network Access Commercial |
$4,371.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,328.36
|
| Rate for Payer: Quartz Commercial |
$2,851.06
|
| Rate for Payer: WEA Trust Commercial |
$2,613.47
|
| Rate for Payer: WPS Commercial |
$3,519.50
|
|
|
ILEOSCOPY THROUGH STOMA WITH BALLOON DILATION
|
Facility
|
OP
|
$4,569.00
|
|
|
Service Code
|
CPT 44381
|
| Hospital Charge Code |
4494796
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,019.44 |
| Max. Negotiated Rate |
$8,077.76 |
| Rate for Payer: Aetna Commercial |
$4,276.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,086.51
|
| Rate for Payer: Aetna Managed Medicare |
$2,019.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,518.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,019.44
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cigna Commercial |
$4,371.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,019.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,019.44
|
| Rate for Payer: Health EOS Commercial |
$4,229.07
|
| Rate for Payer: HFN Commercial |
$4,371.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,512.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,019.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,019.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,019.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,019.44
|
| Rate for Payer: Multiplan Commercial |
$3,801.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,029.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4,371.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,328.36
|
| Rate for Payer: Quartz Commercial |
$3,088.64
|
| Rate for Payer: Quartz Medicare Advantage |
$2,019.44
|
| Rate for Payer: The Alliance Commercial |
$8,077.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,019.44
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$2,613.47
|
| Rate for Payer: Wellcare Medicare |
$2,019.44
|
| Rate for Payer: WPS Commercial |
$3,519.50
|
|
|
ILEOSCOPY THROUGH STOMA WITH STENT PLACEMENT
|
Facility
|
OP
|
$4,892.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
4494795
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,019.44 |
| Max. Negotiated Rate |
$10,303.28 |
| Rate for Payer: Aetna Commercial |
$4,578.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,375.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,019.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,696.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,019.44
|
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cigna Commercial |
$4,680.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,019.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,019.44
|
| Rate for Payer: Health EOS Commercial |
$4,528.04
|
| Rate for Payer: HFN Commercial |
$4,680.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,512.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,019.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,019.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,019.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,019.44
|
| Rate for Payer: Multiplan Commercial |
$4,070.14
|
| Rate for Payer: NAPHCARE Commercial |
$3,029.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4,680.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,492.96
|
| Rate for Payer: Quartz Commercial |
$3,306.99
|
| Rate for Payer: Quartz Medicare Advantage |
$2,019.44
|
| Rate for Payer: The Alliance Commercial |
$8,077.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,019.44
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$2,798.22
|
| Rate for Payer: Wellcare Medicare |
$2,019.44
|
| Rate for Payer: WPS Commercial |
$3,768.31
|
|
|
ILEOSCOPY THROUGH STOMA WITH STENT PLACEMENT
|
Facility
|
IP
|
$4,892.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
4494795
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,492.96 |
| Max. Negotiated Rate |
$4,680.67 |
| Rate for Payer: Aetna Commercial |
$4,578.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,375.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,696.47
|
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cigna Commercial |
$4,680.67
|
| Rate for Payer: Health EOS Commercial |
$4,528.04
|
| Rate for Payer: HFN Commercial |
$4,680.67
|
| Rate for Payer: Multiplan Commercial |
$4,070.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,680.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,492.96
|
| Rate for Payer: Quartz Commercial |
$3,052.61
|
| Rate for Payer: WEA Trust Commercial |
$2,798.22
|
| Rate for Payer: WPS Commercial |
$3,768.31
|
|
|
ILEOSCOPY WITH URETERAL STENT PLACEMENT
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
2960147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$423.70 |
| Max. Negotiated Rate |
$1,392.14 |
| Rate for Payer: Aetna Commercial |
$1,361.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.35
|
| Rate for Payer: Aetna Managed Medicare |
$423.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$983.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$756.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,392.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$846.81
|
| Rate for Payer: Health EOS Commercial |
$1,346.75
|
| Rate for Payer: HFN Commercial |
$1,392.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,134.90
|
| Rate for Payer: Multiplan Commercial |
$1,210.56
|
| Rate for Payer: NAPHCARE Commercial |
$907.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.14
|
| Rate for Payer: Quartz Beloit One Network |
$741.47
|
| Rate for Payer: Quartz Commercial |
$983.58
|
| Rate for Payer: Quartz Medicare Advantage |
$907.92
|
| Rate for Payer: The Alliance Commercial |
$756.60
|
| Rate for Payer: WEA Trust Commercial |
$832.26
|
| Rate for Payer: WPS Commercial |
$1,120.79
|
|
|
ILEOSCOPY WITH URETERAL STENT PLACEMENT
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
2960147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$741.47 |
| Max. Negotiated Rate |
$1,392.14 |
| Rate for Payer: Aetna Commercial |
$1,361.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,392.14
|
| Rate for Payer: Health EOS Commercial |
$1,346.75
|
| Rate for Payer: HFN Commercial |
$1,392.14
|
| Rate for Payer: Multiplan Commercial |
$1,210.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.14
|
| Rate for Payer: Quartz Beloit One Network |
$741.47
|
| Rate for Payer: Quartz Commercial |
$907.92
|
| Rate for Payer: WEA Trust Commercial |
$832.26
|
| Rate for Payer: WPS Commercial |
$1,120.79
|
|
|
ILEOSTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960148
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
ILEOSTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960148
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
ILIAC LIMB
|
Facility
|
IP
|
$23,002.00
|
|
| Hospital Charge Code |
2970591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,721.82 |
| Max. Negotiated Rate |
$22,008.31 |
| Rate for Payer: Aetna Commercial |
$21,529.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,572.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,678.70
|
| Rate for Payer: Cash Price |
$6,900.60
|
| Rate for Payer: Cigna Commercial |
$22,008.31
|
| Rate for Payer: Health EOS Commercial |
$21,290.65
|
| Rate for Payer: HFN Commercial |
$22,008.31
|
| Rate for Payer: Multiplan Commercial |
$19,137.66
|
| Rate for Payer: Preferred Network Access Commercial |
$22,008.31
|
| Rate for Payer: Quartz Beloit One Network |
$11,721.82
|
| Rate for Payer: Quartz Commercial |
$14,353.25
|
| Rate for Payer: WEA Trust Commercial |
$13,157.14
|
| Rate for Payer: WPS Commercial |
$17,718.44
|
|
|
ILIAC LIMB
|
Facility
|
OP
|
$23,002.00
|
|
| Hospital Charge Code |
2970591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,698.18 |
| Max. Negotiated Rate |
$22,008.31 |
| Rate for Payer: Aetna Commercial |
$21,529.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,572.99
|
| Rate for Payer: Aetna Managed Medicare |
$6,698.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,549.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,961.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,482.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,678.70
|
| Rate for Payer: Cash Price |
$6,900.60
|
| Rate for Payer: Cigna Commercial |
$22,008.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,387.16
|
| Rate for Payer: Health EOS Commercial |
$21,290.65
|
| Rate for Payer: HFN Commercial |
$22,008.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,941.56
|
| Rate for Payer: Multiplan Commercial |
$19,137.66
|
| Rate for Payer: NAPHCARE Commercial |
$14,353.25
|
| Rate for Payer: Preferred Network Access Commercial |
$22,008.31
|
| Rate for Payer: Quartz Beloit One Network |
$11,721.82
|
| Rate for Payer: Quartz Commercial |
$15,549.35
|
| Rate for Payer: Quartz Medicare Advantage |
$14,353.25
|
| Rate for Payer: The Alliance Commercial |
$11,961.04
|
| Rate for Payer: WEA Trust Commercial |
$13,157.14
|
| Rate for Payer: WPS Commercial |
$17,718.44
|
|
|
ILIAC LIMB GRAFT PXA260300
|
Facility
|
IP
|
$17,360.00
|
|
| Hospital Charge Code |
2973921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,846.66 |
| Max. Negotiated Rate |
$16,610.05 |
| Rate for Payer: Aetna Commercial |
$16,248.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,526.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,568.83
|
| Rate for Payer: Cash Price |
$5,208.00
|
| Rate for Payer: Cigna Commercial |
$16,610.05
|
| Rate for Payer: Health EOS Commercial |
$16,068.42
|
| Rate for Payer: HFN Commercial |
$16,610.05
|
| Rate for Payer: Multiplan Commercial |
$14,443.52
|
| Rate for Payer: Preferred Network Access Commercial |
$16,610.05
|
| Rate for Payer: Quartz Beloit One Network |
$8,846.66
|
| Rate for Payer: Quartz Commercial |
$10,832.64
|
| Rate for Payer: WEA Trust Commercial |
$9,929.92
|
| Rate for Payer: WPS Commercial |
$13,372.41
|
|
|
ILIAC LIMB GRAFT PXA260300
|
Facility
|
OP
|
$17,360.00
|
|
| Hospital Charge Code |
2973921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,055.23 |
| Max. Negotiated Rate |
$16,610.05 |
| Rate for Payer: Aetna Commercial |
$16,248.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,526.78
|
| Rate for Payer: Aetna Managed Medicare |
$5,055.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,735.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,027.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,666.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,568.83
|
| Rate for Payer: Cash Price |
$5,208.00
|
| Rate for Payer: Cigna Commercial |
$16,610.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,103.52
|
| Rate for Payer: Health EOS Commercial |
$16,068.42
|
| Rate for Payer: HFN Commercial |
$16,610.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,540.80
|
| Rate for Payer: Multiplan Commercial |
$14,443.52
|
| Rate for Payer: NAPHCARE Commercial |
$10,832.64
|
| Rate for Payer: Preferred Network Access Commercial |
$16,610.05
|
| Rate for Payer: Quartz Beloit One Network |
$8,846.66
|
| Rate for Payer: Quartz Commercial |
$11,735.36
|
| Rate for Payer: Quartz Medicare Advantage |
$10,832.64
|
| Rate for Payer: The Alliance Commercial |
$9,027.20
|
| Rate for Payer: WEA Trust Commercial |
$9,929.92
|
| Rate for Payer: WPS Commercial |
$13,372.41
|
|
|
ILIAC LIMB PXC161200
|
Facility
|
IP
|
$21,910.00
|
|
| Hospital Charge Code |
2973939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,165.34 |
| Max. Negotiated Rate |
$20,963.49 |
| Rate for Payer: Aetna Commercial |
$20,507.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,596.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,076.79
|
| Rate for Payer: Cash Price |
$6,573.00
|
| Rate for Payer: Cigna Commercial |
$20,963.49
|
| Rate for Payer: Health EOS Commercial |
$20,279.90
|
| Rate for Payer: HFN Commercial |
$20,963.49
|
| Rate for Payer: Multiplan Commercial |
$18,229.12
|
| Rate for Payer: Preferred Network Access Commercial |
$20,963.49
|
| Rate for Payer: Quartz Beloit One Network |
$11,165.34
|
| Rate for Payer: Quartz Commercial |
$13,671.84
|
| Rate for Payer: WEA Trust Commercial |
$12,532.52
|
| Rate for Payer: WPS Commercial |
$16,877.27
|
|
|
ILIAC LIMB PXC161200
|
Facility
|
OP
|
$21,910.00
|
|
| Hospital Charge Code |
2973939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,380.19 |
| Max. Negotiated Rate |
$20,963.49 |
| Rate for Payer: Aetna Commercial |
$20,507.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,596.30
|
| Rate for Payer: Aetna Managed Medicare |
$6,380.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,811.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,393.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,937.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,076.79
|
| Rate for Payer: Cash Price |
$6,573.00
|
| Rate for Payer: Cigna Commercial |
$20,963.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,751.62
|
| Rate for Payer: Health EOS Commercial |
$20,279.90
|
| Rate for Payer: HFN Commercial |
$20,963.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,089.80
|
| Rate for Payer: Multiplan Commercial |
$18,229.12
|
| Rate for Payer: NAPHCARE Commercial |
$13,671.84
|
| Rate for Payer: Preferred Network Access Commercial |
$20,963.49
|
| Rate for Payer: Quartz Beloit One Network |
$11,165.34
|
| Rate for Payer: Quartz Commercial |
$14,811.16
|
| Rate for Payer: Quartz Medicare Advantage |
$13,671.84
|
| Rate for Payer: The Alliance Commercial |
$11,393.20
|
| Rate for Payer: WEA Trust Commercial |
$12,532.52
|
| Rate for Payer: WPS Commercial |
$16,877.27
|
|
|
ILIAC LYMPHADENECTOMY
|
Facility
|
IP
|
$7,388.00
|
|
| Hospital Charge Code |
2960149
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,764.92 |
| Max. Negotiated Rate |
$7,068.84 |
| Rate for Payer: Aetna Commercial |
$6,915.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,607.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.27
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$7,068.84
|
| Rate for Payer: Health EOS Commercial |
$6,838.33
|
| Rate for Payer: HFN Commercial |
$7,068.84
|
| Rate for Payer: Multiplan Commercial |
$6,146.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,068.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.92
|
| Rate for Payer: Quartz Commercial |
$4,610.11
|
| Rate for Payer: WEA Trust Commercial |
$4,225.94
|
| Rate for Payer: WPS Commercial |
$5,690.98
|
|
|
ILIAC LYMPHADENECTOMY
|
Facility
|
OP
|
$7,388.00
|
|
| Hospital Charge Code |
2960149
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,151.39 |
| Max. Negotiated Rate |
$7,068.84 |
| Rate for Payer: Aetna Commercial |
$6,915.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,607.83
|
| Rate for Payer: Aetna Managed Medicare |
$2,151.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,994.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,841.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,688.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.27
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$7,068.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,299.82
|
| Rate for Payer: Health EOS Commercial |
$6,838.33
|
| Rate for Payer: HFN Commercial |
$7,068.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,762.64
|
| Rate for Payer: Multiplan Commercial |
$6,146.82
|
| Rate for Payer: NAPHCARE Commercial |
$4,610.11
|
| Rate for Payer: Preferred Network Access Commercial |
$7,068.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.92
|
| Rate for Payer: Quartz Commercial |
$4,994.29
|
| Rate for Payer: Quartz Medicare Advantage |
$4,610.11
|
| Rate for Payer: The Alliance Commercial |
$3,841.76
|
| Rate for Payer: WEA Trust Commercial |
$4,225.94
|
| Rate for Payer: WPS Commercial |
$5,690.98
|
|
