|
RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED, EXT 4961822
|
Professional
|
Both
|
$11,290.00
|
|
|
Service Code
|
CPT 49618 22
|
| Hospital Charge Code |
6181710
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$867.98 |
| Max. Negotiated Rate |
$10,725.50 |
| Rate for Payer: Aetna Commercial |
$10,725.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,709.40
|
| Rate for Payer: Cash Price |
$3,387.00
|
| Rate for Payer: Cash Price |
$3,387.00
|
| Rate for Payer: Cash Price |
$3,387.00
|
| Rate for Payer: Cigna Commercial |
$10,725.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$867.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,774.00
|
| Rate for Payer: Health EOS Commercial |
$10,273.90
|
| Rate for Payer: HFN Commercial |
$10,725.50
|
| Rate for Payer: Multiplan Commercial |
$9,032.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,725.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,967.60
|
| Rate for Payer: Quartz Commercial |
$6,435.30
|
| Rate for Payer: The Alliance Commercial |
$5,645.00
|
| Rate for Payer: United Healthcare Medicaid |
$867.98
|
| Rate for Payer: WEA Trust Commercial |
$6,209.50
|
| Rate for Payer: WPS Commercial |
$8,362.50
|
|
|
RPR AA HERNIA RECR > 10 CM REDUCIBLE 49617
|
Professional
|
Both
|
$6,968.00
|
|
|
Service Code
|
CPT 49617
|
| Hospital Charge Code |
6179922
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$620.44 |
| Max. Negotiated Rate |
$6,619.60 |
| Rate for Payer: Aetna Commercial |
$6,619.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,992.48
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cigna Commercial |
$6,619.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$620.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,180.80
|
| Rate for Payer: Health EOS Commercial |
$6,340.88
|
| Rate for Payer: HFN Commercial |
$6,619.60
|
| Rate for Payer: Multiplan Commercial |
$5,574.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,619.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,065.92
|
| Rate for Payer: Quartz Commercial |
$3,971.76
|
| Rate for Payer: The Alliance Commercial |
$3,484.00
|
| Rate for Payer: United Healthcare Medicaid |
$620.44
|
| Rate for Payer: WEA Trust Commercial |
$3,832.40
|
| Rate for Payer: WPS Commercial |
$5,161.20
|
|
|
RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED 49616
|
Professional
|
Both
|
$6,911.00
|
|
|
Service Code
|
CPT 49616
|
| Hospital Charge Code |
6179889
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$600.46 |
| Max. Negotiated Rate |
$6,565.45 |
| Rate for Payer: Aetna Commercial |
$6,565.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,943.46
|
| Rate for Payer: Cash Price |
$2,073.30
|
| Rate for Payer: Cash Price |
$2,073.30
|
| Rate for Payer: Cash Price |
$2,073.30
|
| Rate for Payer: Cigna Commercial |
$6,565.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$600.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,146.60
|
| Rate for Payer: Health EOS Commercial |
$6,289.01
|
| Rate for Payer: HFN Commercial |
$6,565.45
|
| Rate for Payer: Multiplan Commercial |
$5,528.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,565.45
|
| Rate for Payer: Quartz Beloit One Network |
$3,040.84
|
| Rate for Payer: Quartz Commercial |
$3,939.27
|
| Rate for Payer: The Alliance Commercial |
$3,455.50
|
| Rate for Payer: United Healthcare Medicaid |
$600.46
|
| Rate for Payer: WEA Trust Commercial |
$3,801.05
|
| Rate for Payer: WPS Commercial |
$5,118.98
|
|
|
RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED EXTENDED 4961622
|
Professional
|
Both
|
$8,293.00
|
|
|
Service Code
|
CPT 49616 22
|
| Hospital Charge Code |
6179888
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$600.46 |
| Max. Negotiated Rate |
$7,878.35 |
| Rate for Payer: Aetna Commercial |
$7,878.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,131.98
|
| Rate for Payer: Cash Price |
$2,487.90
|
| Rate for Payer: Cash Price |
$2,487.90
|
| Rate for Payer: Cash Price |
$2,487.90
|
| Rate for Payer: Cigna Commercial |
$7,878.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$600.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,975.80
|
| Rate for Payer: Health EOS Commercial |
$7,546.63
|
| Rate for Payer: HFN Commercial |
$7,878.35
|
| Rate for Payer: Multiplan Commercial |
$6,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,878.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,648.92
|
| Rate for Payer: Quartz Commercial |
$4,727.01
|
| Rate for Payer: The Alliance Commercial |
$4,146.50
|
| Rate for Payer: United Healthcare Medicaid |
$600.46
|
| Rate for Payer: WEA Trust Commercial |
$4,561.15
|
| Rate for Payer: WPS Commercial |
$6,142.63
|
|
|
RPR AA HERNIA RECR 3-10 CM REDUCIBLE 49615
|
Professional
|
Both
|
$5,368.00
|
|
|
Service Code
|
CPT 49615
|
| Hospital Charge Code |
6179921
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$447.71 |
| Max. Negotiated Rate |
$5,099.60 |
| Rate for Payer: Aetna Commercial |
$5,099.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,616.48
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cigna Commercial |
$5,099.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$447.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,220.80
|
| Rate for Payer: Health EOS Commercial |
$4,884.88
|
| Rate for Payer: HFN Commercial |
$5,099.60
|
| Rate for Payer: Multiplan Commercial |
$4,294.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,099.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,361.92
|
| Rate for Payer: Quartz Commercial |
$3,059.76
|
| Rate for Payer: The Alliance Commercial |
$2,684.00
|
| Rate for Payer: United Healthcare Medicaid |
$447.71
|
| Rate for Payer: WEA Trust Commercial |
$2,952.40
|
| Rate for Payer: WPS Commercial |
$3,976.08
|
|
|
RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED 49614
|
Professional
|
Both
|
$3,895.00
|
|
|
Service Code
|
CPT 49614
|
| Hospital Charge Code |
6179920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.15 |
| Max. Negotiated Rate |
$3,700.25 |
| Rate for Payer: Aetna Commercial |
$3,700.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,349.70
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cigna Commercial |
$3,700.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$400.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,337.00
|
| Rate for Payer: Health EOS Commercial |
$3,544.45
|
| Rate for Payer: HFN Commercial |
$3,700.25
|
| Rate for Payer: Multiplan Commercial |
$3,116.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,700.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,713.80
|
| Rate for Payer: Quartz Commercial |
$2,220.15
|
| Rate for Payer: The Alliance Commercial |
$1,947.50
|
| Rate for Payer: United Healthcare Medicaid |
$400.15
|
| Rate for Payer: WEA Trust Commercial |
$2,142.25
|
| Rate for Payer: WPS Commercial |
$2,885.03
|
|
|
RPR AA HERNIA RECR < 3 CM REDUCIBLE 49613
|
Professional
|
Both
|
$3,743.00
|
|
|
Service Code
|
CPT 49613
|
| Hospital Charge Code |
6179919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$295.87 |
| Max. Negotiated Rate |
$3,555.85 |
| Rate for Payer: Aetna Commercial |
$3,555.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,218.98
|
| Rate for Payer: Cash Price |
$1,122.90
|
| Rate for Payer: Cash Price |
$1,122.90
|
| Rate for Payer: Cash Price |
$1,122.90
|
| Rate for Payer: Cigna Commercial |
$3,555.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$295.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,245.80
|
| Rate for Payer: Health EOS Commercial |
$3,406.13
|
| Rate for Payer: HFN Commercial |
$3,555.85
|
| Rate for Payer: Multiplan Commercial |
$2,994.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,555.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,646.92
|
| Rate for Payer: Quartz Commercial |
$2,133.51
|
| Rate for Payer: The Alliance Commercial |
$1,871.50
|
| Rate for Payer: United Healthcare Medicaid |
$295.87
|
| Rate for Payer: WEA Trust Commercial |
$2,058.65
|
| Rate for Payer: WPS Commercial |
$2,772.44
|
|
|
RPR AARPR AA HERNIA RECR > 10 CM REDUCIBLE, EXT 4961722
|
Professional
|
Both
|
$8,362.00
|
|
|
Service Code
|
CPT 49617 22
|
| Hospital Charge Code |
6186963
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$620.44 |
| Max. Negotiated Rate |
$7,943.90 |
| Rate for Payer: Aetna Commercial |
$7,943.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,191.32
|
| Rate for Payer: Cash Price |
$2,508.60
|
| Rate for Payer: Cash Price |
$2,508.60
|
| Rate for Payer: Cash Price |
$2,508.60
|
| Rate for Payer: Cigna Commercial |
$7,943.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$620.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,017.20
|
| Rate for Payer: Health EOS Commercial |
$7,609.42
|
| Rate for Payer: HFN Commercial |
$7,943.90
|
| Rate for Payer: Multiplan Commercial |
$6,689.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,943.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,679.28
|
| Rate for Payer: Quartz Commercial |
$4,766.34
|
| Rate for Payer: The Alliance Commercial |
$4,181.00
|
| Rate for Payer: United Healthcare Medicaid |
$620.44
|
| Rate for Payer: WEA Trust Commercial |
$4,599.10
|
| Rate for Payer: WPS Commercial |
$6,193.73
|
|
|
RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL 67901
|
Professional
|
Both
|
$4,420.00
|
|
|
Service Code
|
CPT 67901
|
| Hospital Charge Code |
6242599
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$889.43 |
| Max. Negotiated Rate |
$4,199.00 |
| Rate for Payer: Aetna Commercial |
$4,199.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,801.20
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cigna Commercial |
$4,199.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$889.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,652.00
|
| Rate for Payer: Health EOS Commercial |
$4,022.20
|
| Rate for Payer: HFN Commercial |
$4,199.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,976.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,976.20
|
| Rate for Payer: Multiplan Commercial |
$3,536.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,199.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,944.80
|
| Rate for Payer: Quartz Commercial |
$2,519.40
|
| Rate for Payer: The Alliance Commercial |
$2,210.00
|
| Rate for Payer: United Healthcare Medicaid |
$889.43
|
| Rate for Payer: WEA Trust Commercial |
$2,431.00
|
| Rate for Payer: WPS Commercial |
$3,273.89
|
|
|
RPR BLPOS Conjunctivo-Tarso-Mus 67908
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
CPT 67908
|
| Hospital Charge Code |
5102674
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$677.97 |
| Max. Negotiated Rate |
$3,054.25 |
| Rate for Payer: Aetna Commercial |
$3,054.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,764.90
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$3,054.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$677.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,929.00
|
| Rate for Payer: Health EOS Commercial |
$2,925.65
|
| Rate for Payer: HFN Commercial |
$3,054.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,450.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,450.16
|
| Rate for Payer: Multiplan Commercial |
$2,572.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,054.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.60
|
| Rate for Payer: Quartz Commercial |
$1,832.55
|
| Rate for Payer: The Alliance Commercial |
$1,607.50
|
| Rate for Payer: United Healthcare Medicaid |
$677.97
|
| Rate for Payer: WEA Trust Commercial |
$1,768.25
|
| Rate for Payer: WPS Commercial |
$2,381.35
|
|
|
RPR BLPOS Conjunctivo-Tarso-Mus 6790850
|
Professional
|
Both
|
$6,430.00
|
|
|
Service Code
|
CPT 67908 50
|
| Hospital Charge Code |
5102675
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$677.97 |
| Max. Negotiated Rate |
$6,108.50 |
| Rate for Payer: Aetna Commercial |
$6,108.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,529.80
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cigna Commercial |
$6,108.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$677.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,858.00
|
| Rate for Payer: Health EOS Commercial |
$5,851.30
|
| Rate for Payer: HFN Commercial |
$6,108.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,450.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,450.16
|
| Rate for Payer: Multiplan Commercial |
$5,144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,108.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,829.20
|
| Rate for Payer: Quartz Commercial |
$3,665.10
|
| Rate for Payer: The Alliance Commercial |
$3,215.00
|
| Rate for Payer: United Healthcare Medicaid |
$677.97
|
| Rate for Payer: WEA Trust Commercial |
$3,536.50
|
| Rate for Payer: WPS Commercial |
$4,762.70
|
|
|
RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT 36576
|
Professional
|
Both
|
$1,376.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
6242814
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.65 |
| Max. Negotiated Rate |
$1,307.20 |
| Rate for Payer: Aetna Commercial |
$1,307.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,183.36
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,307.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$409.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$825.60
|
| Rate for Payer: Health EOS Commercial |
$1,252.16
|
| Rate for Payer: HFN Commercial |
$1,307.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$603.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$603.77
|
| Rate for Payer: Multiplan Commercial |
$1,100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,307.20
|
| Rate for Payer: Quartz Beloit One Network |
$605.44
|
| Rate for Payer: Quartz Commercial |
$784.32
|
| Rate for Payer: The Alliance Commercial |
$688.00
|
| Rate for Payer: United Healthcare Medicaid |
$409.65
|
| Rate for Payer: WEA Trust Commercial |
$756.80
|
| Rate for Payer: WPS Commercial |
$1,019.20
|
|
|
RPR NSL VLV COLLAPSE LW NRG SUBQ/SBMCSL RMDLG 30469
|
Professional
|
Both
|
$9,812.00
|
|
|
Service Code
|
CPT 30469
|
| Hospital Charge Code |
6243937
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,317.28 |
| Max. Negotiated Rate |
$9,321.40 |
| Rate for Payer: Aetna Commercial |
$9,321.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,438.32
|
| Rate for Payer: Cash Price |
$2,943.60
|
| Rate for Payer: Cash Price |
$2,943.60
|
| Rate for Payer: Cigna Commercial |
$9,321.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,906.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,887.20
|
| Rate for Payer: Health EOS Commercial |
$8,928.92
|
| Rate for Payer: HFN Commercial |
$9,321.40
|
| Rate for Payer: Multiplan Commercial |
$7,849.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,321.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,317.28
|
| Rate for Payer: Quartz Commercial |
$5,592.84
|
| Rate for Payer: The Alliance Commercial |
$4,906.00
|
| Rate for Payer: WEA Trust Commercial |
$5,396.60
|
| Rate for Payer: WPS Commercial |
$7,267.75
|
|
|
RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT - 30468
|
Professional
|
Both
|
$3,824.00
|
|
|
Service Code
|
CPT 30468
|
| Hospital Charge Code |
5923671
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$554.81 |
| Max. Negotiated Rate |
$3,632.80 |
| Rate for Payer: Aetna Commercial |
$3,632.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,288.64
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cigna Commercial |
$3,632.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,912.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,294.40
|
| Rate for Payer: Health EOS Commercial |
$3,479.84
|
| Rate for Payer: HFN Commercial |
$3,632.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$554.81
|
| Rate for Payer: Multiplan Commercial |
$3,059.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,632.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.56
|
| Rate for Payer: Quartz Commercial |
$2,179.68
|
| Rate for Payer: The Alliance Commercial |
$1,912.00
|
| Rate for Payer: WEA Trust Commercial |
$2,103.20
|
| Rate for Payer: WPS Commercial |
$2,832.44
|
|
|
RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE 49621
|
Professional
|
Both
|
$7,592.00
|
|
|
Service Code
|
CPT 49621
|
| Hospital Charge Code |
6180266
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$524.37 |
| Max. Negotiated Rate |
$7,212.40 |
| Rate for Payer: Aetna Commercial |
$7,212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,529.12
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cigna Commercial |
$7,212.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$524.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,555.20
|
| Rate for Payer: Health EOS Commercial |
$6,908.72
|
| Rate for Payer: HFN Commercial |
$7,212.40
|
| Rate for Payer: Multiplan Commercial |
$6,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,212.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,340.48
|
| Rate for Payer: Quartz Commercial |
$4,327.44
|
| Rate for Payer: The Alliance Commercial |
$3,796.00
|
| Rate for Payer: United Healthcare Medicaid |
$524.37
|
| Rate for Payer: WEA Trust Commercial |
$4,175.60
|
| Rate for Payer: WPS Commercial |
$5,623.39
|
|
|
RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE, EXT 4962122
|
Professional
|
Both
|
$7,592.00
|
|
|
Service Code
|
CPT 49621 22
|
| Hospital Charge Code |
6180267
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$524.37 |
| Max. Negotiated Rate |
$7,212.40 |
| Rate for Payer: Aetna Commercial |
$7,212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,529.12
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cigna Commercial |
$7,212.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$524.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,555.20
|
| Rate for Payer: Health EOS Commercial |
$6,908.72
|
| Rate for Payer: HFN Commercial |
$7,212.40
|
| Rate for Payer: Multiplan Commercial |
$6,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,212.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,340.48
|
| Rate for Payer: Quartz Commercial |
$4,327.44
|
| Rate for Payer: The Alliance Commercial |
$3,796.00
|
| Rate for Payer: United Healthcare Medicaid |
$524.37
|
| Rate for Payer: WEA Trust Commercial |
$4,175.60
|
| Rate for Payer: WPS Commercial |
$5,623.39
|
|
|
RPR PARASTOMAL HRNA 1ST/RECR NCRC8/STRANGULATED 49622
|
Professional
|
Both
|
$9,464.00
|
|
|
Service Code
|
CPT 49622
|
| Hospital Charge Code |
6180268
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$647.28 |
| Max. Negotiated Rate |
$8,990.80 |
| Rate for Payer: Aetna Commercial |
$8,990.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,139.04
|
| Rate for Payer: Cash Price |
$2,839.20
|
| Rate for Payer: Cash Price |
$2,839.20
|
| Rate for Payer: Cash Price |
$2,839.20
|
| Rate for Payer: Cigna Commercial |
$8,990.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$647.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,678.40
|
| Rate for Payer: Health EOS Commercial |
$8,612.24
|
| Rate for Payer: HFN Commercial |
$8,990.80
|
| Rate for Payer: Multiplan Commercial |
$7,571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,990.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,164.16
|
| Rate for Payer: Quartz Commercial |
$5,394.48
|
| Rate for Payer: The Alliance Commercial |
$4,732.00
|
| Rate for Payer: United Healthcare Medicaid |
$647.28
|
| Rate for Payer: WEA Trust Commercial |
$5,205.20
|
| Rate for Payer: WPS Commercial |
$7,009.98
|
|
|
.RPR Titer
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
5208633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
.RPR Titer
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
5208633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| Rate for Payer: HFN Commercial |
$19.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.53
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$19.95
|
| Rate for Payer: Quartz Beloit One Network |
$9.24
|
| Rate for Payer: Quartz Commercial |
$11.97
|
| Rate for Payer: The Alliance Commercial |
$10.50
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
.RPR Titer
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
5208633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$4.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.30
|
| Rate for Payer: Anthem Medicaid |
$4.55
|
| Rate for Payer: Anthem Medicare Advantage |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.40
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.75
|
| Rate for Payer: Dean Health Medicaid |
$4.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.40
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.40
|
| Rate for Payer: Managed Health Services Medicaid |
$4.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.55
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4.40
|
| Rate for Payer: The Alliance Commercial |
$17.60
|
| Rate for Payer: United Healthcare Medicaid |
$4.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.40
|
| Rate for Payer: United Healthcare PPO |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$4.40
|
| Rate for Payer: WMAP Medicaid |
$4.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
RPR w/Rfx Titer and Treponema Pallidum
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5432852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.09
|
| Rate for Payer: Anthem Medicaid |
$4.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Dean Health Medicaid |
$4.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Managed Health Services Medicaid |
$4.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.41
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$17.08
|
| Rate for Payer: United Healthcare Medicaid |
$4.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare PPO |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
| Rate for Payer: WMAP Medicaid |
$4.41
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
RPR w/Rfx Titer and Treponema Pallidum
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5432852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
RPR w/Rfx Titer and Treponema Pallidum
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5432852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.00
|
| Rate for Payer: Health EOS Commercial |
$72.80
|
| Rate for Payer: HFN Commercial |
$76.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.07
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Preferred Network Access Commercial |
$76.00
|
| Rate for Payer: Quartz Beloit One Network |
$35.20
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
RSV IG, IM, 50MG 90378
|
Facility
|
OP
|
$2,944.00
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
3873516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$339.68 |
| Max. Negotiated Rate |
$2,708.48 |
| Rate for Payer: Aetna Commercial |
$2,649.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,531.84
|
| Rate for Payer: Aetna Managed Medicare |
$339.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,913.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,472.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,413.12
|
| Rate for Payer: Anthem Medicare Advantage |
$339.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$339.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$339.68
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,708.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$339.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,647.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$339.68
|
| Rate for Payer: Health EOS Commercial |
$2,620.16
|
| Rate for Payer: HFN Commercial |
$2,708.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,263.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$339.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$339.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$339.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$339.68
|
| Rate for Payer: Multiplan Commercial |
$2,355.20
|
| Rate for Payer: NAPHCARE Commercial |
$509.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,708.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,442.56
|
| Rate for Payer: Quartz Commercial |
$1,913.60
|
| Rate for Payer: Quartz Medicare Advantage |
$339.68
|
| Rate for Payer: The Alliance Commercial |
$1,358.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.68
|
| Rate for Payer: WEA Trust Commercial |
$1,619.20
|
| Rate for Payer: Wellcare Medicare |
$339.68
|
| Rate for Payer: WPS Commercial |
$2,180.62
|
|
|
RSV IG, IM, 50MG 90378
|
Facility
|
IP
|
$2,944.00
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
3873516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,442.56 |
| Max. Negotiated Rate |
$2,708.48 |
| Rate for Payer: Aetna Commercial |
$2,649.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,531.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.32
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,708.48
|
| Rate for Payer: Health EOS Commercial |
$2,620.16
|
| Rate for Payer: HFN Commercial |
$2,708.48
|
| Rate for Payer: Multiplan Commercial |
$2,355.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,766.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,708.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,442.56
|
| Rate for Payer: Quartz Commercial |
$1,766.40
|
| Rate for Payer: WEA Trust Commercial |
$1,619.20
|
| Rate for Payer: WPS Commercial |
$2,180.62
|
|
