|
REMOVE BLADDER/REVISE TRACT 51595
|
Professional
|
Both
|
$12,086.00
|
|
|
Service Code
|
CPT 51595
|
| Hospital Charge Code |
3014972
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,331.37 |
| Max. Negotiated Rate |
$11,481.70 |
| Rate for Payer: Aetna Commercial |
$11,481.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,393.96
|
| Rate for Payer: Cash Price |
$3,625.80
|
| Rate for Payer: Cash Price |
$3,625.80
|
| Rate for Payer: Cash Price |
$3,625.80
|
| Rate for Payer: Cigna Commercial |
$11,481.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,331.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,251.60
|
| Rate for Payer: Health EOS Commercial |
$10,998.26
|
| Rate for Payer: HFN Commercial |
$11,481.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,287.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,287.97
|
| Rate for Payer: Multiplan Commercial |
$9,668.80
|
| Rate for Payer: Preferred Network Access Commercial |
$11,481.70
|
| Rate for Payer: Quartz Beloit One Network |
$5,317.84
|
| Rate for Payer: Quartz Commercial |
$6,889.02
|
| Rate for Payer: The Alliance Commercial |
$6,043.00
|
| Rate for Payer: United Healthcare Medicaid |
$2,331.37
|
| Rate for Payer: WEA Trust Commercial |
$6,647.30
|
| Rate for Payer: WPS Commercial |
$8,952.10
|
|
|
REMOVE BLADDER/REVISE TRACT, EXT 5159022
|
Professional
|
Both
|
$12,752.00
|
|
|
Service Code
|
CPT 51590 22
|
| Hospital Charge Code |
6243936
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,109.31 |
| Max. Negotiated Rate |
$12,114.40 |
| Rate for Payer: Aetna Commercial |
$12,114.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,966.72
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cigna Commercial |
$12,114.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,109.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,651.20
|
| Rate for Payer: Health EOS Commercial |
$11,604.32
|
| Rate for Payer: HFN Commercial |
$12,114.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,439.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,439.28
|
| Rate for Payer: Multiplan Commercial |
$10,201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,114.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,610.88
|
| Rate for Payer: Quartz Commercial |
$7,268.64
|
| Rate for Payer: The Alliance Commercial |
$6,376.00
|
| Rate for Payer: United Healthcare Medicaid |
$2,109.31
|
| Rate for Payer: WEA Trust Commercial |
$7,013.60
|
| Rate for Payer: WPS Commercial |
$9,445.41
|
|
|
REMOVE BLADDER/REVISE TRACT, EXT 5159522
|
Professional
|
Both
|
$14,507.00
|
|
|
Service Code
|
CPT 51595 22
|
| Hospital Charge Code |
6243513
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,331.37 |
| Max. Negotiated Rate |
$13,781.65 |
| Rate for Payer: Aetna Commercial |
$13,781.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,476.02
|
| Rate for Payer: Cash Price |
$4,352.10
|
| Rate for Payer: Cash Price |
$4,352.10
|
| Rate for Payer: Cash Price |
$4,352.10
|
| Rate for Payer: Cigna Commercial |
$13,781.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,331.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,704.20
|
| Rate for Payer: Health EOS Commercial |
$13,201.37
|
| Rate for Payer: HFN Commercial |
$13,781.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,287.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,287.97
|
| Rate for Payer: Multiplan Commercial |
$11,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,781.65
|
| Rate for Payer: Quartz Beloit One Network |
$6,383.08
|
| Rate for Payer: Quartz Commercial |
$8,268.99
|
| Rate for Payer: The Alliance Commercial |
$7,253.50
|
| Rate for Payer: United Healthcare Medicaid |
$2,331.37
|
| Rate for Payer: WEA Trust Commercial |
$7,978.85
|
| Rate for Payer: WPS Commercial |
$10,745.33
|
|
|
REMOVE BLADDER STONE 52317
|
Professional
|
Both
|
$4,944.00
|
|
|
Service Code
|
CPT 52317
|
| Hospital Charge Code |
3014992
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$359.49 |
| Max. Negotiated Rate |
$4,696.80 |
| Rate for Payer: Aetna Commercial |
$4,696.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,251.84
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cigna Commercial |
$4,696.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$359.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,966.40
|
| Rate for Payer: Health EOS Commercial |
$4,499.04
|
| Rate for Payer: HFN Commercial |
$4,696.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,152.40
|
| Rate for Payer: Multiplan Commercial |
$3,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,696.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,175.36
|
| Rate for Payer: Quartz Commercial |
$2,818.08
|
| Rate for Payer: The Alliance Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare Medicaid |
$359.49
|
| Rate for Payer: WEA Trust Commercial |
$2,719.20
|
| Rate for Payer: WPS Commercial |
$3,662.02
|
|
|
REMOVE BONE FIXATION DEVICE 20694
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
CPT 20694
|
| Hospital Charge Code |
3013712
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$353.95 |
| Max. Negotiated Rate |
$1,128.86 |
| Rate for Payer: Aetna Commercial |
$1,121.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.66
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cigna Commercial |
$1,121.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$353.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$708.60
|
| Rate for Payer: Health EOS Commercial |
$1,074.71
|
| Rate for Payer: HFN Commercial |
$1,121.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,128.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,128.86
|
| Rate for Payer: Multiplan Commercial |
$944.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,121.95
|
| Rate for Payer: Quartz Beloit One Network |
$519.64
|
| Rate for Payer: Quartz Commercial |
$673.17
|
| Rate for Payer: The Alliance Commercial |
$590.50
|
| Rate for Payer: United Healthcare Medicaid |
$353.95
|
| Rate for Payer: WEA Trust Commercial |
$649.55
|
| Rate for Payer: WPS Commercial |
$874.77
|
|
|
Remove Drug Implant Device 1198222
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
CPT 11982 22
|
| Hospital Charge Code |
4253428
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.74 |
| Max. Negotiated Rate |
$504.45 |
| Rate for Payer: Aetna Commercial |
$504.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.66
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$504.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.60
|
| Rate for Payer: Health EOS Commercial |
$483.21
|
| Rate for Payer: HFN Commercial |
$504.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.95
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: Preferred Network Access Commercial |
$504.45
|
| Rate for Payer: Quartz Beloit One Network |
$233.64
|
| Rate for Payer: Quartz Commercial |
$302.67
|
| Rate for Payer: The Alliance Commercial |
$265.50
|
| Rate for Payer: United Healthcare Medicaid |
$91.74
|
| Rate for Payer: WEA Trust Commercial |
$292.05
|
| Rate for Payer: WPS Commercial |
$393.31
|
|
|
REMOVE EAR CANAL LESION(S) 69145
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
3015263
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.78 |
| Max. Negotiated Rate |
$858.11 |
| Rate for Payer: Aetna Commercial |
$678.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$678.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.40
|
| Rate for Payer: Health EOS Commercial |
$649.74
|
| Rate for Payer: HFN Commercial |
$678.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$858.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$858.11
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$678.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.16
|
| Rate for Payer: Quartz Commercial |
$406.98
|
| Rate for Payer: The Alliance Commercial |
$357.00
|
| Rate for Payer: United Healthcare Medicaid |
$151.78
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
REMOVE EYELID FOREIGN BODY 67938
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
3015251
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.71 |
| Max. Negotiated Rate |
$683.05 |
| Rate for Payer: Aetna Commercial |
$683.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.34
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$683.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$431.40
|
| Rate for Payer: Health EOS Commercial |
$654.29
|
| Rate for Payer: HFN Commercial |
$683.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$394.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.87
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: Preferred Network Access Commercial |
$683.05
|
| Rate for Payer: Quartz Beloit One Network |
$316.36
|
| Rate for Payer: Quartz Commercial |
$409.83
|
| Rate for Payer: The Alliance Commercial |
$359.50
|
| Rate for Payer: United Healthcare Medicaid |
$64.71
|
| Rate for Payer: WEA Trust Commercial |
$395.45
|
| Rate for Payer: WPS Commercial |
$532.56
|
|
|
REMOVE EYELID LINING LESION 68110
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
CPT 68110
|
| Hospital Charge Code |
3015253
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.23 |
| Max. Negotiated Rate |
$825.55 |
| Rate for Payer: Aetna Commercial |
$825.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$747.34
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna Commercial |
$825.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$521.40
|
| Rate for Payer: Health EOS Commercial |
$790.79
|
| Rate for Payer: HFN Commercial |
$825.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$497.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$497.31
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: Preferred Network Access Commercial |
$825.55
|
| Rate for Payer: Quartz Beloit One Network |
$382.36
|
| Rate for Payer: Quartz Commercial |
$495.33
|
| Rate for Payer: The Alliance Commercial |
$434.50
|
| Rate for Payer: United Healthcare Medicaid |
$91.23
|
| Rate for Payer: WEA Trust Commercial |
$477.95
|
| Rate for Payer: WPS Commercial |
$643.67
|
|
|
REMOVE FOREIGN BODY FROM EYE 65220
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
3015219
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.10 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Aetna Commercial |
$348.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$348.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.20
|
| Rate for Payer: Health EOS Commercial |
$333.97
|
| Rate for Payer: HFN Commercial |
$348.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.31
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Preferred Network Access Commercial |
$348.65
|
| Rate for Payer: Quartz Beloit One Network |
$161.48
|
| Rate for Payer: Quartz Commercial |
$209.19
|
| Rate for Payer: The Alliance Commercial |
$183.50
|
| Rate for Payer: United Healthcare Medicaid |
$46.10
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
REMOVE HIP FOREIGN BODY 27086
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
CPT 27086
|
| Hospital Charge Code |
3014012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$559.36 |
| Rate for Payer: Aetna Commercial |
$542.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.06
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$542.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$342.60
|
| Rate for Payer: Health EOS Commercial |
$519.61
|
| Rate for Payer: HFN Commercial |
$542.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$559.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$559.36
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: Preferred Network Access Commercial |
$542.45
|
| Rate for Payer: Quartz Beloit One Network |
$251.24
|
| Rate for Payer: Quartz Commercial |
$325.47
|
| Rate for Payer: The Alliance Commercial |
$285.50
|
| Rate for Payer: United Healthcare Medicaid |
$39.10
|
| Rate for Payer: WEA Trust Commercial |
$314.05
|
| Rate for Payer: WPS Commercial |
$422.94
|
|
|
Remove Impacted Cerumen using Irrigation/lavage 69209
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
5034612
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Aetna Commercial |
$203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$203.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.40
|
| Rate for Payer: Health EOS Commercial |
$194.74
|
| Rate for Payer: HFN Commercial |
$203.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.27
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Preferred Network Access Commercial |
$203.30
|
| Rate for Payer: Quartz Beloit One Network |
$94.16
|
| Rate for Payer: Quartz Commercial |
$121.98
|
| Rate for Payer: The Alliance Commercial |
$107.00
|
| Rate for Payer: United Healthcare Medicaid |
$9.74
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
Remove Impacted Cerumen w/instrumentation 69210
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
1188959
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.00
|
| Rate for Payer: Health EOS Commercial |
$118.30
|
| Rate for Payer: HFN Commercial |
$123.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$123.50
|
| Rate for Payer: Quartz Beloit One Network |
$57.20
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: The Alliance Commercial |
$65.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.85
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Remove Impacted Ear Wax 69210
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
3713511
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.00
|
| Rate for Payer: Health EOS Commercial |
$118.30
|
| Rate for Payer: HFN Commercial |
$123.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$123.50
|
| Rate for Payer: Quartz Beloit One Network |
$57.20
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: The Alliance Commercial |
$65.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.85
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Remove Impacted Ear Wax 6921050
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
CPT 69210 50
|
| Hospital Charge Code |
3245542
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$247.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$247.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.00
|
| Rate for Payer: Health EOS Commercial |
$236.60
|
| Rate for Payer: HFN Commercial |
$247.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$247.00
|
| Rate for Payer: Quartz Beloit One Network |
$114.40
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: The Alliance Commercial |
$130.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.85
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
REMOVE/INSERT DRUG IMPLANT 11983
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
3013582
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.16 |
| Max. Negotiated Rate |
$473.10 |
| Rate for Payer: Aetna Commercial |
$473.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.28
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$473.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.80
|
| Rate for Payer: Health EOS Commercial |
$453.18
|
| Rate for Payer: HFN Commercial |
$473.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$340.93
|
| Rate for Payer: Multiplan Commercial |
$398.40
|
| Rate for Payer: Preferred Network Access Commercial |
$473.10
|
| Rate for Payer: Quartz Beloit One Network |
$219.12
|
| Rate for Payer: Quartz Commercial |
$283.86
|
| Rate for Payer: The Alliance Commercial |
$249.00
|
| Rate for Payer: United Healthcare Medicaid |
$153.16
|
| Rate for Payer: WEA Trust Commercial |
$273.90
|
| Rate for Payer: WPS Commercial |
$368.87
|
|
|
Remove/Insert Drug Implant 1198322
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
CPT 11983 22
|
| Hospital Charge Code |
4500624
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.16 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Aetna Commercial |
$568.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$568.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.80
|
| Rate for Payer: Health EOS Commercial |
$544.18
|
| Rate for Payer: HFN Commercial |
$568.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$340.93
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Preferred Network Access Commercial |
$568.10
|
| Rate for Payer: Quartz Beloit One Network |
$263.12
|
| Rate for Payer: Quartz Commercial |
$340.86
|
| Rate for Payer: The Alliance Commercial |
$299.00
|
| Rate for Payer: United Healthcare Medicaid |
$153.16
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
Remove Intrauterine Device 5830122
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
CPT 58301 22
|
| Hospital Charge Code |
4253625
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Aetna Commercial |
$426.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.14
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$426.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$269.40
|
| Rate for Payer: Health EOS Commercial |
$408.59
|
| Rate for Payer: HFN Commercial |
$426.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.59
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Preferred Network Access Commercial |
$426.55
|
| Rate for Payer: Quartz Beloit One Network |
$197.56
|
| Rate for Payer: Quartz Commercial |
$255.93
|
| Rate for Payer: The Alliance Commercial |
$224.50
|
| Rate for Payer: United Healthcare Medicaid |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$246.95
|
| Rate for Payer: WPS Commercial |
$332.57
|
|
|
REMOVE LESION, BACK OR FLANK 21930
|
Professional
|
Both
|
$2,363.00
|
|
|
Service Code
|
CPT 21930
|
| Hospital Charge Code |
3013747
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$390.21 |
| Max. Negotiated Rate |
$2,244.85 |
| Rate for Payer: Aetna Commercial |
$2,244.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,032.18
|
| Rate for Payer: Cash Price |
$708.90
|
| Rate for Payer: Cash Price |
$708.90
|
| Rate for Payer: Cash Price |
$708.90
|
| Rate for Payer: Cigna Commercial |
$2,244.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$390.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,417.80
|
| Rate for Payer: Health EOS Commercial |
$2,150.33
|
| Rate for Payer: HFN Commercial |
$2,244.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,198.33
|
| Rate for Payer: Multiplan Commercial |
$1,890.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.72
|
| Rate for Payer: Quartz Commercial |
$1,346.91
|
| Rate for Payer: The Alliance Commercial |
$1,181.50
|
| Rate for Payer: United Healthcare Medicaid |
$390.21
|
| Rate for Payer: WEA Trust Commercial |
$1,299.65
|
| Rate for Payer: WPS Commercial |
$1,750.27
|
|
|
REMOVE LESION, BACK OR FLANK 3cm Or GREATER 21931
|
Professional
|
Both
|
$3,719.00
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
3013748
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$378.15 |
| Max. Negotiated Rate |
$3,533.05 |
| Rate for Payer: Aetna Commercial |
$3,533.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,198.34
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cigna Commercial |
$3,533.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$378.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,231.40
|
| Rate for Payer: Health EOS Commercial |
$3,384.29
|
| Rate for Payer: HFN Commercial |
$3,533.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,534.70
|
| Rate for Payer: Multiplan Commercial |
$2,975.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,533.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,636.36
|
| Rate for Payer: Quartz Commercial |
$2,119.83
|
| Rate for Payer: The Alliance Commercial |
$1,859.50
|
| Rate for Payer: United Healthcare Medicaid |
$378.15
|
| Rate for Payer: WEA Trust Commercial |
$2,045.45
|
| Rate for Payer: WPS Commercial |
$2,754.66
|
|
|
REMOVE LESION, NECK/CHEST 21555
|
Professional
|
Both
|
$1,028.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
3013739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.74 |
| Max. Negotiated Rate |
$1,010.11 |
| Rate for Payer: Aetna Commercial |
$976.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$884.08
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$976.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.80
|
| Rate for Payer: Health EOS Commercial |
$935.48
|
| Rate for Payer: HFN Commercial |
$976.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,010.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,010.11
|
| Rate for Payer: Multiplan Commercial |
$822.40
|
| Rate for Payer: Preferred Network Access Commercial |
$976.60
|
| Rate for Payer: Quartz Beloit One Network |
$452.32
|
| Rate for Payer: Quartz Commercial |
$585.96
|
| Rate for Payer: The Alliance Commercial |
$514.00
|
| Rate for Payer: United Healthcare Medicaid |
$83.74
|
| Rate for Payer: WEA Trust Commercial |
$565.40
|
| Rate for Payer: WPS Commercial |
$761.44
|
|
|
REMOVE LOWER LEG LESION 27618
|
Professional
|
Both
|
$1,194.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
3014114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.35 |
| Max. Negotiated Rate |
$1,134.30 |
| Rate for Payer: Aetna Commercial |
$1,134.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,026.84
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$1,134.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$209.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.40
|
| Rate for Payer: Health EOS Commercial |
$1,086.54
|
| Rate for Payer: HFN Commercial |
$1,134.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,010.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,010.18
|
| Rate for Payer: Multiplan Commercial |
$955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.30
|
| Rate for Payer: Quartz Beloit One Network |
$525.36
|
| Rate for Payer: Quartz Commercial |
$680.58
|
| Rate for Payer: The Alliance Commercial |
$597.00
|
| Rate for Payer: United Healthcare Medicaid |
$209.35
|
| Rate for Payer: WEA Trust Commercial |
$656.70
|
| Rate for Payer: WPS Commercial |
$884.40
|
|
|
REMOVE MESH FROM ABD WALL, UNL 2299911008
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
CPT 22999
|
| Hospital Charge Code |
6171942
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$538.12 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Aetna Commercial |
$1,161.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,051.78
|
| Rate for Payer: Cash Price |
$366.90
|
| Rate for Payer: Cash Price |
$366.90
|
| Rate for Payer: Cigna Commercial |
$1,161.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$611.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$733.80
|
| Rate for Payer: Health EOS Commercial |
$1,112.93
|
| Rate for Payer: HFN Commercial |
$1,161.85
|
| Rate for Payer: Multiplan Commercial |
$978.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,161.85
|
| Rate for Payer: Quartz Beloit One Network |
$538.12
|
| Rate for Payer: Quartz Commercial |
$697.11
|
| Rate for Payer: The Alliance Commercial |
$611.50
|
| Rate for Payer: WEA Trust Commercial |
$672.65
|
| Rate for Payer: WPS Commercial |
$905.88
|
|
|
REMOVER ANASTOCLIP UNIVERSAL CLIP DISP 4001-00
|
Facility
|
OP
|
$1,731.00
|
|
| Hospital Charge Code |
5298749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$484.68 |
| Max. Negotiated Rate |
$6,924.00 |
| Rate for Payer: Aetna Commercial |
$1,557.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,488.66
|
| Rate for Payer: Aetna Managed Medicare |
$484.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,125.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$865.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$830.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.43
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cigna Commercial |
$1,592.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$968.67
|
| Rate for Payer: Health EOS Commercial |
$1,540.59
|
| Rate for Payer: HFN Commercial |
$1,592.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,298.25
|
| Rate for Payer: Multiplan Commercial |
$1,384.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,038.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.52
|
| Rate for Payer: Quartz Beloit One Network |
$848.19
|
| Rate for Payer: Quartz Commercial |
$1,125.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,038.60
|
| Rate for Payer: The Alliance Commercial |
$6,924.00
|
| Rate for Payer: WEA Trust Commercial |
$952.05
|
| Rate for Payer: WPS Commercial |
$1,282.15
|
|
|
REMOVER ANASTOCLIP UNIVERSAL CLIP DISP 4001-00
|
Facility
|
IP
|
$1,731.00
|
|
| Hospital Charge Code |
5298749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$848.19 |
| Max. Negotiated Rate |
$1,592.52 |
| Rate for Payer: Aetna Commercial |
$1,557.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,488.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.43
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cigna Commercial |
$1,592.52
|
| Rate for Payer: Health EOS Commercial |
$1,540.59
|
| Rate for Payer: HFN Commercial |
$1,592.52
|
| Rate for Payer: Multiplan Commercial |
$1,384.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,038.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.52
|
| Rate for Payer: Quartz Beloit One Network |
$848.19
|
| Rate for Payer: Quartz Commercial |
$1,038.60
|
| Rate for Payer: WEA Trust Commercial |
$952.05
|
| Rate for Payer: WPS Commercial |
$1,282.15
|
|
