|
IIBD Serology 7 Prom
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2776819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.12 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$259.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.68
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$264.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$256.32
|
| Rate for Payer: HFN Commercial |
$264.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$264.96
|
| Rate for Payer: Quartz Beloit One Network |
$141.12
|
| Rate for Payer: Quartz Commercial |
$187.20
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: The Alliance Commercial |
$675.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$216.00
|
| Rate for Payer: WEA Trust Commercial |
$158.40
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$213.32
|
|
|
IIBD Serology 7 Prom
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2776819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.12 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$259.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.64
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$264.96
|
| Rate for Payer: Health EOS Commercial |
$256.32
|
| Rate for Payer: HFN Commercial |
$264.96
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: NAPHCARE Commercial |
$172.80
|
| Rate for Payer: Preferred Network Access Commercial |
$264.96
|
| Rate for Payer: Quartz Beloit One Network |
$141.12
|
| Rate for Payer: Quartz Commercial |
$172.80
|
| Rate for Payer: WEA Trust Commercial |
$158.40
|
| Rate for Payer: WPS Commercial |
$213.32
|
|
|
ILEO CONDUIT
|
Facility
|
IP
|
$7,912.00
|
|
| Hospital Charge Code |
2960145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,876.88 |
| Max. Negotiated Rate |
$7,279.04 |
| Rate for Payer: Aetna Commercial |
$7,120.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,804.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,193.36
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,279.04
|
| Rate for Payer: Health EOS Commercial |
$7,041.68
|
| Rate for Payer: HFN Commercial |
$7,279.04
|
| Rate for Payer: Multiplan Commercial |
$6,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,279.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,876.88
|
| Rate for Payer: Quartz Commercial |
$4,747.20
|
| Rate for Payer: WEA Trust Commercial |
$4,351.60
|
| Rate for Payer: WPS Commercial |
$5,860.42
|
|
|
ILEO CONDUIT
|
Facility
|
OP
|
$7,912.00
|
|
| Hospital Charge Code |
2960145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,215.36 |
| Max. Negotiated Rate |
$31,648.00 |
| Rate for Payer: Aetna Commercial |
$7,120.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,804.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,215.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,142.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,956.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,797.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,193.36
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,279.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,427.56
|
| Rate for Payer: Health EOS Commercial |
$7,041.68
|
| Rate for Payer: HFN Commercial |
$7,279.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,934.00
|
| Rate for Payer: Multiplan Commercial |
$6,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,279.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,876.88
|
| Rate for Payer: Quartz Commercial |
$5,142.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,747.20
|
| Rate for Payer: The Alliance Commercial |
$31,648.00
|
| Rate for Payer: WEA Trust Commercial |
$4,351.60
|
| Rate for Payer: WPS Commercial |
$5,860.42
|
|
|
ILEO FEMORAL BYPASS GRAFT
|
Facility
|
IP
|
$16,069.00
|
|
| Hospital Charge Code |
2960146
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,873.81 |
| Max. Negotiated Rate |
$14,783.48 |
| Rate for Payer: Aetna Commercial |
$14,462.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,819.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,516.57
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$14,783.48
|
| Rate for Payer: Health EOS Commercial |
$14,301.41
|
| Rate for Payer: HFN Commercial |
$14,783.48
|
| Rate for Payer: Multiplan Commercial |
$12,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,873.81
|
| Rate for Payer: Quartz Commercial |
$9,641.40
|
| Rate for Payer: WEA Trust Commercial |
$8,837.95
|
| Rate for Payer: WPS Commercial |
$11,902.31
|
|
|
ILEO FEMORAL BYPASS GRAFT
|
Facility
|
OP
|
$16,069.00
|
|
| Hospital Charge Code |
2960146
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,499.32 |
| Max. Negotiated Rate |
$64,276.00 |
| Rate for Payer: Aetna Commercial |
$14,462.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,819.34
|
| Rate for Payer: Aetna Managed Medicare |
$4,499.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,444.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,034.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,713.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,516.57
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$14,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,992.21
|
| Rate for Payer: Health EOS Commercial |
$14,301.41
|
| Rate for Payer: HFN Commercial |
$14,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,051.75
|
| Rate for Payer: Multiplan Commercial |
$12,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,873.81
|
| Rate for Payer: Quartz Commercial |
$10,444.85
|
| Rate for Payer: Quartz Medicare Advantage |
$9,641.40
|
| Rate for Payer: The Alliance Commercial |
$64,276.00
|
| Rate for Payer: WEA Trust Commercial |
$8,837.95
|
| Rate for Payer: WPS Commercial |
$11,902.31
|
|
|
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 |
$2,238.81 |
| Max. Negotiated Rate |
$4,203.48 |
| Rate for Payer: Aetna Commercial |
$4,112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,929.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,421.57
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cigna Commercial |
$4,203.48
|
| Rate for Payer: Health EOS Commercial |
$4,066.41
|
| Rate for Payer: HFN Commercial |
$4,203.48
|
| Rate for Payer: Multiplan Commercial |
$3,655.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,741.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,203.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,238.81
|
| Rate for Payer: Quartz Commercial |
$2,741.40
|
| Rate for Payer: WEA Trust Commercial |
$2,512.95
|
| Rate for Payer: WPS Commercial |
$3,384.26
|
|
|
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 |
$1,880.76 |
| Max. Negotiated Rate |
$7,523.04 |
| Rate for Payer: Aetna Commercial |
$4,112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,929.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,880.76
|
| 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 |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,421.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,880.76
|
| 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 |
$4,203.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,880.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,880.76
|
| Rate for Payer: Health EOS Commercial |
$4,066.41
|
| Rate for Payer: HFN Commercial |
$4,203.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,996.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,880.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,880.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,880.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,880.76
|
| Rate for Payer: Multiplan Commercial |
$3,655.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,203.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,238.81
|
| Rate for Payer: Quartz Commercial |
$2,969.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,880.76
|
| Rate for Payer: The Alliance Commercial |
$7,523.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,880.76
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$2,512.95
|
| Rate for Payer: Wellcare Medicare |
$1,880.76
|
| Rate for Payer: WPS Commercial |
$3,384.26
|
|
|
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 |
$2,397.08 |
| Max. Negotiated Rate |
$4,500.64 |
| Rate for Payer: Aetna Commercial |
$4,402.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,207.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,592.76
|
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cigna Commercial |
$4,500.64
|
| Rate for Payer: Health EOS Commercial |
$4,353.88
|
| Rate for Payer: HFN Commercial |
$4,500.64
|
| Rate for Payer: Multiplan Commercial |
$3,913.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,935.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,500.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,397.08
|
| Rate for Payer: Quartz Commercial |
$2,935.20
|
| Rate for Payer: WEA Trust Commercial |
$2,690.60
|
| Rate for Payer: WPS Commercial |
$3,623.50
|
|
|
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 |
$1,880.76 |
| Max. Negotiated Rate |
$9,907.00 |
| Rate for Payer: Aetna Commercial |
$4,402.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,207.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,880.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,592.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,880.76
|
| 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 |
$4,500.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,880.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,880.76
|
| Rate for Payer: Health EOS Commercial |
$4,353.88
|
| Rate for Payer: HFN Commercial |
$4,500.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,996.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,880.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,880.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,880.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,880.76
|
| Rate for Payer: Multiplan Commercial |
$3,913.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,500.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,397.08
|
| Rate for Payer: Quartz Commercial |
$3,179.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,880.76
|
| Rate for Payer: The Alliance Commercial |
$7,523.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,880.76
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$2,690.60
|
| Rate for Payer: Wellcare Medicare |
$1,880.76
|
| Rate for Payer: WPS Commercial |
$3,623.50
|
|
|
ILEOSCOPY WITH URETERAL STENT PLACEMENT
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
2960147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$5,820.00 |
| Rate for Payer: Aetna Commercial |
$1,309.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.30
|
| Rate for Payer: Aetna Managed Medicare |
$407.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$727.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$698.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.15
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,338.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.22
|
| Rate for Payer: Health EOS Commercial |
$1,294.95
|
| Rate for Payer: HFN Commercial |
$1,338.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,091.25
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$873.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.60
|
| Rate for Payer: Quartz Beloit One Network |
$712.95
|
| Rate for Payer: Quartz Commercial |
$945.75
|
| Rate for Payer: Quartz Medicare Advantage |
$873.00
|
| Rate for Payer: The Alliance Commercial |
$5,820.00
|
| Rate for Payer: WEA Trust Commercial |
$800.25
|
| Rate for Payer: WPS Commercial |
$1,077.72
|
|
|
ILEOSCOPY WITH URETERAL STENT PLACEMENT
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
2960147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$712.95 |
| Max. Negotiated Rate |
$1,338.60 |
| Rate for Payer: Aetna Commercial |
$1,309.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.15
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,338.60
|
| Rate for Payer: Health EOS Commercial |
$1,294.95
|
| Rate for Payer: HFN Commercial |
$1,338.60
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$873.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.60
|
| Rate for Payer: Quartz Beloit One Network |
$712.95
|
| Rate for Payer: Quartz Commercial |
$873.00
|
| Rate for Payer: WEA Trust Commercial |
$800.25
|
| Rate for Payer: WPS Commercial |
$1,077.72
|
|
|
ILEOSTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960148
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
ILEOSTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960148
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
ILIAC LIMB
|
Facility
|
IP
|
$23,002.00
|
|
| Hospital Charge Code |
2970591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,270.98 |
| Max. Negotiated Rate |
$21,161.84 |
| Rate for Payer: Aetna Commercial |
$20,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,781.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,191.06
|
| Rate for Payer: Cash Price |
$6,900.60
|
| Rate for Payer: Cigna Commercial |
$21,161.84
|
| Rate for Payer: Health EOS Commercial |
$20,471.78
|
| Rate for Payer: HFN Commercial |
$21,161.84
|
| Rate for Payer: Multiplan Commercial |
$18,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$13,801.20
|
| Rate for Payer: Preferred Network Access Commercial |
$21,161.84
|
| Rate for Payer: Quartz Beloit One Network |
$11,270.98
|
| Rate for Payer: Quartz Commercial |
$13,801.20
|
| Rate for Payer: WEA Trust Commercial |
$12,651.10
|
| Rate for Payer: WPS Commercial |
$17,037.58
|
|
|
ILIAC LIMB
|
Facility
|
OP
|
$23,002.00
|
|
| Hospital Charge Code |
2970591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,440.56 |
| Max. Negotiated Rate |
$92,008.00 |
| Rate for Payer: Aetna Commercial |
$20,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,781.72
|
| Rate for Payer: Aetna Managed Medicare |
$6,440.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,951.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,501.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,040.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,191.06
|
| Rate for Payer: Cash Price |
$6,900.60
|
| Rate for Payer: Cigna Commercial |
$21,161.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,871.92
|
| Rate for Payer: Health EOS Commercial |
$20,471.78
|
| Rate for Payer: HFN Commercial |
$21,161.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,251.50
|
| Rate for Payer: Multiplan Commercial |
$18,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$13,801.20
|
| Rate for Payer: Preferred Network Access Commercial |
$21,161.84
|
| Rate for Payer: Quartz Beloit One Network |
$11,270.98
|
| Rate for Payer: Quartz Commercial |
$14,951.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13,801.20
|
| Rate for Payer: The Alliance Commercial |
$92,008.00
|
| Rate for Payer: WEA Trust Commercial |
$12,651.10
|
| Rate for Payer: WPS Commercial |
$17,037.58
|
|
|
ILIAC LIMB GRAFT PXA260300
|
Facility
|
IP
|
$17,360.00
|
|
| Hospital Charge Code |
2973921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,506.40 |
| Max. Negotiated Rate |
$15,971.20 |
| Rate for Payer: Aetna Commercial |
$15,624.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,929.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,200.80
|
| Rate for Payer: Cash Price |
$5,208.00
|
| Rate for Payer: Cigna Commercial |
$15,971.20
|
| Rate for Payer: Health EOS Commercial |
$15,450.40
|
| Rate for Payer: HFN Commercial |
$15,971.20
|
| Rate for Payer: Multiplan Commercial |
$13,888.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,416.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,971.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,506.40
|
| Rate for Payer: Quartz Commercial |
$10,416.00
|
| Rate for Payer: WEA Trust Commercial |
$9,548.00
|
| Rate for Payer: WPS Commercial |
$12,858.55
|
|
|
ILIAC LIMB GRAFT PXA260300
|
Facility
|
OP
|
$17,360.00
|
|
| Hospital Charge Code |
2973921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,860.80 |
| Max. Negotiated Rate |
$69,440.00 |
| Rate for Payer: Aetna Commercial |
$15,624.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,929.60
|
| Rate for Payer: Aetna Managed Medicare |
$4,860.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,284.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,680.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,332.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,200.80
|
| Rate for Payer: Cash Price |
$5,208.00
|
| Rate for Payer: Cigna Commercial |
$15,971.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,714.66
|
| Rate for Payer: Health EOS Commercial |
$15,450.40
|
| Rate for Payer: HFN Commercial |
$15,971.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,020.00
|
| Rate for Payer: Multiplan Commercial |
$13,888.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,416.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,971.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,506.40
|
| Rate for Payer: Quartz Commercial |
$11,284.00
|
| Rate for Payer: Quartz Medicare Advantage |
$10,416.00
|
| Rate for Payer: The Alliance Commercial |
$69,440.00
|
| Rate for Payer: WEA Trust Commercial |
$9,548.00
|
| Rate for Payer: WPS Commercial |
$12,858.55
|
|
|
ILIAC LIMB PXC161200
|
Facility
|
IP
|
$21,910.00
|
|
| Hospital Charge Code |
2973939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,735.90 |
| Max. Negotiated Rate |
$20,157.20 |
| Rate for Payer: Aetna Commercial |
$19,719.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,842.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,612.30
|
| Rate for Payer: Cash Price |
$6,573.00
|
| Rate for Payer: Cigna Commercial |
$20,157.20
|
| Rate for Payer: Health EOS Commercial |
$19,499.90
|
| Rate for Payer: HFN Commercial |
$20,157.20
|
| Rate for Payer: Multiplan Commercial |
$17,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$13,146.00
|
| Rate for Payer: Preferred Network Access Commercial |
$20,157.20
|
| Rate for Payer: Quartz Beloit One Network |
$10,735.90
|
| Rate for Payer: Quartz Commercial |
$13,146.00
|
| Rate for Payer: WEA Trust Commercial |
$12,050.50
|
| Rate for Payer: WPS Commercial |
$16,228.74
|
|
|
ILIAC LIMB PXC161200
|
Facility
|
OP
|
$21,910.00
|
|
| Hospital Charge Code |
2973939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,134.80 |
| Max. Negotiated Rate |
$87,640.00 |
| Rate for Payer: Aetna Commercial |
$19,719.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,842.60
|
| Rate for Payer: Aetna Managed Medicare |
$6,134.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,241.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,955.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,516.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,612.30
|
| Rate for Payer: Cash Price |
$6,573.00
|
| Rate for Payer: Cigna Commercial |
$20,157.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,260.84
|
| Rate for Payer: Health EOS Commercial |
$19,499.90
|
| Rate for Payer: HFN Commercial |
$20,157.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,432.50
|
| Rate for Payer: Multiplan Commercial |
$17,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$13,146.00
|
| Rate for Payer: Preferred Network Access Commercial |
$20,157.20
|
| Rate for Payer: Quartz Beloit One Network |
$10,735.90
|
| Rate for Payer: Quartz Commercial |
$14,241.50
|
| Rate for Payer: Quartz Medicare Advantage |
$13,146.00
|
| Rate for Payer: The Alliance Commercial |
$87,640.00
|
| Rate for Payer: WEA Trust Commercial |
$12,050.50
|
| Rate for Payer: WPS Commercial |
$16,228.74
|
|
|
ILIAC LYMPHADENECTOMY
|
Facility
|
IP
|
$7,388.00
|
|
| Hospital Charge Code |
2960149
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,620.12 |
| Max. Negotiated Rate |
$6,796.96 |
| Rate for Payer: Aetna Commercial |
$6,649.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,353.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.64
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$6,796.96
|
| Rate for Payer: Health EOS Commercial |
$6,575.32
|
| Rate for Payer: HFN Commercial |
$6,796.96
|
| Rate for Payer: Multiplan Commercial |
$5,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.12
|
| Rate for Payer: Quartz Commercial |
$4,432.80
|
| Rate for Payer: WEA Trust Commercial |
$4,063.40
|
| Rate for Payer: WPS Commercial |
$5,472.29
|
|
|
ILIAC LYMPHADENECTOMY
|
Facility
|
OP
|
$7,388.00
|
|
| Hospital Charge Code |
2960149
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,068.64 |
| Max. Negotiated Rate |
$29,552.00 |
| Rate for Payer: Aetna Commercial |
$6,649.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,353.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,068.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,802.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,694.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,546.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.64
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$6,796.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,134.32
|
| Rate for Payer: Health EOS Commercial |
$6,575.32
|
| Rate for Payer: HFN Commercial |
$6,796.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,541.00
|
| Rate for Payer: Multiplan Commercial |
$5,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.12
|
| Rate for Payer: Quartz Commercial |
$4,802.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,432.80
|
| Rate for Payer: The Alliance Commercial |
$29,552.00
|
| Rate for Payer: WEA Trust Commercial |
$4,063.40
|
| Rate for Payer: WPS Commercial |
$5,472.29
|
|
|
Iloperidone Level
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
5581590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Aetna Commercial |
$602.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.24
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$602.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$317.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$380.40
|
| Rate for Payer: Health EOS Commercial |
$576.94
|
| Rate for Payer: HFN Commercial |
$602.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: Preferred Network Access Commercial |
$602.30
|
| Rate for Payer: Quartz Beloit One Network |
$278.96
|
| Rate for Payer: Quartz Commercial |
$361.38
|
| Rate for Payer: The Alliance Commercial |
$317.00
|
| Rate for Payer: WEA Trust Commercial |
$348.70
|
| Rate for Payer: WPS Commercial |
$469.60
|
|
|
Iloperidone Level
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
5581590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$177.52 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: Aetna Commercial |
$570.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.24
|
| Rate for Payer: Aetna Managed Medicare |
$177.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$412.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$317.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$304.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.02
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$583.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.79
|
| Rate for Payer: Health EOS Commercial |
$564.26
|
| Rate for Payer: HFN Commercial |
$583.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.50
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: NAPHCARE Commercial |
$380.40
|
| Rate for Payer: Preferred Network Access Commercial |
$583.28
|
| Rate for Payer: Quartz Beloit One Network |
$310.66
|
| Rate for Payer: Quartz Commercial |
$412.10
|
| Rate for Payer: Quartz Medicare Advantage |
$380.40
|
| Rate for Payer: The Alliance Commercial |
$2,536.00
|
| Rate for Payer: United Healthcare PPO |
$475.50
|
| Rate for Payer: WEA Trust Commercial |
$348.70
|
| Rate for Payer: WPS Commercial |
$469.60
|
|
|
Iloperidone Level
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
5581590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$310.66 |
| Max. Negotiated Rate |
$583.28 |
| Rate for Payer: Aetna Commercial |
$570.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.02
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$583.28
|
| Rate for Payer: Health EOS Commercial |
$564.26
|
| Rate for Payer: HFN Commercial |
$583.28
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: NAPHCARE Commercial |
$380.40
|
| Rate for Payer: Preferred Network Access Commercial |
$583.28
|
| Rate for Payer: Quartz Beloit One Network |
$310.66
|
| Rate for Payer: Quartz Commercial |
$380.40
|
| Rate for Payer: WEA Trust Commercial |
$348.70
|
| Rate for Payer: WPS Commercial |
$469.60
|
|
