|
MASTECTOMY, MODIFIED RADICAL
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE
|
Facility
|
OP
|
$25,781.96
|
|
|
Service Code
|
CPT 19307
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,154.00 |
| Max. Negotiated Rate |
$25,781.96 |
| Rate for Payer: The Alliance Commercial |
$25,781.96
|
| Rate for Payer: Aetna Managed Medicare |
$6,445.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6,445.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,445.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,445.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,445.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,445.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,977.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,445.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,445.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,445.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,445.49
|
| Rate for Payer: NAPHCARE Commercial |
$9,668.24
|
| Rate for Payer: Quartz Medicare Advantage |
$6,445.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,445.49
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: Wellcare Medicare |
$6,445.49
|
|
|
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);
|
Facility
|
OP
|
$15,070.20
|
|
|
Service Code
|
CPT 19301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,767.55 |
| Max. Negotiated Rate |
$15,070.20 |
| Rate for Payer: Aetna Managed Medicare |
$3,767.55
|
| 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 |
$3,767.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,015.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.55
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.55
|
| Rate for Payer: The Alliance Commercial |
$15,070.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.55
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,767.55
|
|
|
MASTECTOMY, SIMPLE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2950476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
MASTECTOMY, SIMPLE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2950476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
MASTECTOMY, SIMPLE, COMPLETE
|
Facility
|
OP
|
$25,781.96
|
|
|
Service Code
|
CPT 19303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,154.00 |
| Max. Negotiated Rate |
$25,781.96 |
| Rate for Payer: Aetna Managed Medicare |
$6,445.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6,445.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,445.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,445.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,445.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,445.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,977.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,445.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,445.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,445.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,445.49
|
| Rate for Payer: NAPHCARE Commercial |
$9,668.24
|
| Rate for Payer: Quartz Medicare Advantage |
$6,445.49
|
| Rate for Payer: The Alliance Commercial |
$25,781.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,445.49
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: Wellcare Medicare |
$6,445.49
|
|
|
MA Stereotactic Localization Bilateral
|
Facility
|
OP
|
$6,094.00
|
|
|
Service Code
|
CPT 19081 LT
|
| Hospital Charge Code |
1268835
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Commercial |
$5,484.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,961.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,047.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,925.12
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,229.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,606.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$5,423.66
|
| Rate for Payer: HFN Commercial |
$5,606.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5,606.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,986.06
|
| Rate for Payer: Quartz Commercial |
$3,961.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$4,570.50
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
MA Stereotactic Localization Bilateral
|
Facility
|
IP
|
$6,094.00
|
|
|
Service Code
|
CPT 19081 LT
|
| Hospital Charge Code |
1268835
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$2,986.06 |
| Max. Negotiated Rate |
$5,606.48 |
| Rate for Payer: Aetna Commercial |
$5,484.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,229.82
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,606.48
|
| Rate for Payer: Health EOS Commercial |
$5,423.66
|
| Rate for Payer: HFN Commercial |
$5,606.48
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,656.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,606.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,986.06
|
| Rate for Payer: Quartz Commercial |
$3,656.40
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
MA Stereotactic Localization Bilateral
|
Professional
|
Both
|
$6,094.00
|
|
|
Service Code
|
CPT 19081 LT
|
| Hospital Charge Code |
1268835
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$130.97 |
| Max. Negotiated Rate |
$5,789.30 |
| Rate for Payer: Aetna Commercial |
$5,789.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,789.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,656.40
|
| Rate for Payer: Health EOS Commercial |
$5,545.54
|
| Rate for Payer: HFN Commercial |
$5,789.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$554.99
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,789.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,681.36
|
| Rate for Payer: Quartz Commercial |
$3,473.58
|
| Rate for Payer: The Alliance Commercial |
$3,047.00
|
| Rate for Payer: United Healthcare Medicaid |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
MA Stereotactic Localization Left
|
Facility
|
IP
|
$6,094.00
|
|
|
Service Code
|
CPT 19081 LT
|
| Hospital Charge Code |
1268837
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$2,986.06 |
| Max. Negotiated Rate |
$5,606.48 |
| Rate for Payer: Aetna Commercial |
$5,484.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,229.82
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,606.48
|
| Rate for Payer: Health EOS Commercial |
$5,423.66
|
| Rate for Payer: HFN Commercial |
$5,606.48
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,656.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,606.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,986.06
|
| Rate for Payer: Quartz Commercial |
$3,656.40
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
MA Stereotactic Localization Left
|
Facility
|
OP
|
$6,094.00
|
|
|
Service Code
|
CPT 19081 LT
|
| Hospital Charge Code |
1268837
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Commercial |
$5,484.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,961.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,047.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,925.12
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,229.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,606.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$5,423.66
|
| Rate for Payer: HFN Commercial |
$5,606.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5,606.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,986.06
|
| Rate for Payer: Quartz Commercial |
$3,961.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$4,570.50
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
MA Stereotactic Localization Left
|
Professional
|
Both
|
$6,094.00
|
|
|
Service Code
|
CPT 19081 LT
|
| Hospital Charge Code |
1268837
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$130.97 |
| Max. Negotiated Rate |
$5,789.30 |
| Rate for Payer: Aetna Commercial |
$5,789.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,789.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,656.40
|
| Rate for Payer: Health EOS Commercial |
$5,545.54
|
| Rate for Payer: HFN Commercial |
$5,789.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$554.99
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,789.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,681.36
|
| Rate for Payer: Quartz Commercial |
$3,473.58
|
| Rate for Payer: The Alliance Commercial |
$3,047.00
|
| Rate for Payer: United Healthcare Medicaid |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
MA Stereotactic Localization Right
|
Professional
|
Both
|
$6,094.00
|
|
|
Service Code
|
CPT 19081 RT
|
| Hospital Charge Code |
1268839
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$130.97 |
| Max. Negotiated Rate |
$5,789.30 |
| Rate for Payer: Aetna Commercial |
$5,789.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,789.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,656.40
|
| Rate for Payer: Health EOS Commercial |
$5,545.54
|
| Rate for Payer: HFN Commercial |
$5,789.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$554.99
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,789.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,681.36
|
| Rate for Payer: Quartz Commercial |
$3,473.58
|
| Rate for Payer: The Alliance Commercial |
$3,047.00
|
| Rate for Payer: United Healthcare Medicaid |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
MA Stereotactic Localization Right
|
Facility
|
IP
|
$6,094.00
|
|
|
Service Code
|
CPT 19082 RT
|
| Hospital Charge Code |
6166213
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$2,986.06 |
| Max. Negotiated Rate |
$5,606.48 |
| Rate for Payer: Aetna Commercial |
$5,484.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,229.82
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,606.48
|
| Rate for Payer: Health EOS Commercial |
$5,423.66
|
| Rate for Payer: HFN Commercial |
$5,606.48
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,656.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,606.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,986.06
|
| Rate for Payer: Quartz Commercial |
$3,656.40
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
MA Stereotactic Localization Right
|
Facility
|
OP
|
$6,094.00
|
|
|
Service Code
|
CPT 19082 RT
|
| Hospital Charge Code |
6166213
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$1,706.32 |
| Max. Negotiated Rate |
$24,376.00 |
| Rate for Payer: Aetna Commercial |
$5,484.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,706.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,961.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,047.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,925.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,229.82
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,606.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Health EOS Commercial |
$5,423.66
|
| Rate for Payer: HFN Commercial |
$5,606.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,570.50
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,656.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,606.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,986.06
|
| Rate for Payer: Quartz Commercial |
$3,961.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,656.40
|
| Rate for Payer: The Alliance Commercial |
$24,376.00
|
| Rate for Payer: United Healthcare PPO |
$4,570.50
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
MA Stereotactic Localization Right
|
Professional
|
Both
|
$6,094.00
|
|
|
Service Code
|
CPT 19082 RT
|
| Hospital Charge Code |
6166213
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$63.59 |
| Max. Negotiated Rate |
$5,789.30 |
| Rate for Payer: Aetna Commercial |
$5,789.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,789.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,656.40
|
| Rate for Payer: Health EOS Commercial |
$5,545.54
|
| Rate for Payer: HFN Commercial |
$5,789.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$278.69
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,789.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,681.36
|
| Rate for Payer: Quartz Commercial |
$3,473.58
|
| Rate for Payer: The Alliance Commercial |
$3,047.00
|
| Rate for Payer: United Healthcare Medicaid |
$63.59
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
MA Stereotactic Localization Right
|
Facility
|
OP
|
$6,094.00
|
|
|
Service Code
|
CPT 19081 RT
|
| Hospital Charge Code |
1268839
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Commercial |
$5,484.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,961.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,047.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,925.12
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,229.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,606.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$5,423.66
|
| Rate for Payer: HFN Commercial |
$5,606.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5,606.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,986.06
|
| Rate for Payer: Quartz Commercial |
$3,961.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$4,570.50
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
MA Stereotactic Localization Right
|
Facility
|
IP
|
$6,094.00
|
|
|
Service Code
|
CPT 19081 RT
|
| Hospital Charge Code |
1268839
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$2,986.06 |
| Max. Negotiated Rate |
$5,606.48 |
| Rate for Payer: Aetna Commercial |
$5,484.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,240.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,229.82
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$5,606.48
|
| Rate for Payer: Health EOS Commercial |
$5,423.66
|
| Rate for Payer: HFN Commercial |
$5,606.48
|
| Rate for Payer: Multiplan Commercial |
$4,875.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,656.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,606.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,986.06
|
| Rate for Payer: Quartz Commercial |
$3,656.40
|
| Rate for Payer: WEA Trust Commercial |
$3,351.70
|
| Rate for Payer: WPS Commercial |
$4,513.83
|
|
|
Mastisol UD [Med]
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
2974960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Mastisol UD [Med]
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
2974960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Managed Medicare |
$7.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.99
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$16.25
|
| Rate for Payer: Quartz Medicare Advantage |
$15.00
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
MASTOIDECTOMY
|
Facility
|
IP
|
$7,513.00
|
|
| Hospital Charge Code |
2960224
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,681.37 |
| Max. Negotiated Rate |
$6,911.96 |
| Rate for Payer: Aetna Commercial |
$6,761.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,461.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,981.89
|
| Rate for Payer: Cash Price |
$2,253.90
|
| Rate for Payer: Cigna Commercial |
$6,911.96
|
| Rate for Payer: Health EOS Commercial |
$6,686.57
|
| Rate for Payer: HFN Commercial |
$6,911.96
|
| Rate for Payer: Multiplan Commercial |
$6,010.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,507.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,911.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,681.37
|
| Rate for Payer: Quartz Commercial |
$4,507.80
|
| Rate for Payer: WEA Trust Commercial |
$4,132.15
|
| Rate for Payer: WPS Commercial |
$5,564.88
|
|
|
MASTOIDECTOMY
|
Facility
|
OP
|
$7,513.00
|
|
| Hospital Charge Code |
2960224
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,103.64 |
| Max. Negotiated Rate |
$30,052.00 |
| Rate for Payer: Aetna Commercial |
$6,761.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,461.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,103.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,883.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,756.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,606.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,981.89
|
| Rate for Payer: Cash Price |
$2,253.90
|
| Rate for Payer: Cigna Commercial |
$6,911.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,204.27
|
| Rate for Payer: Health EOS Commercial |
$6,686.57
|
| Rate for Payer: HFN Commercial |
$6,911.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,634.75
|
| Rate for Payer: Multiplan Commercial |
$6,010.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,507.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,911.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,681.37
|
| Rate for Payer: Quartz Commercial |
$4,883.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,507.80
|
| Rate for Payer: The Alliance Commercial |
$30,052.00
|
| Rate for Payer: WEA Trust Commercial |
$4,132.15
|
| Rate for Payer: WPS Commercial |
$5,564.88
|
|
|
MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
OP
|
$6,409.96
|
|
|
Service Code
|
CPT 19020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| 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 |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
|
|
Matrix Metalloproteinase-9 (MMP-9)
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$148.80
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
Matrix Metalloproteinase-9 (MMP-9)
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Aetna Commercial |
$235.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$235.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.80
|
| Rate for Payer: Health EOS Commercial |
$225.68
|
| Rate for Payer: HFN Commercial |
$235.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Preferred Network Access Commercial |
$235.60
|
| Rate for Payer: Quartz Beloit One Network |
$109.12
|
| Rate for Payer: Quartz Commercial |
$141.36
|
| Rate for Payer: The Alliance Commercial |
$124.00
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
