|
REMOTE CONTROL IRRIGATION IRD200
|
Facility
|
IP
|
$1,358.00
|
|
| Hospital Charge Code |
3884889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$692.04 |
| Max. Negotiated Rate |
$1,299.33 |
| Rate for Payer: Aetna Commercial |
$1,271.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$748.53
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$1,299.33
|
| Rate for Payer: Health EOS Commercial |
$1,256.96
|
| Rate for Payer: HFN Commercial |
$1,299.33
|
| Rate for Payer: Multiplan Commercial |
$1,129.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.33
|
| Rate for Payer: Quartz Beloit One Network |
$692.04
|
| Rate for Payer: Quartz Commercial |
$847.39
|
| Rate for Payer: WEA Trust Commercial |
$776.78
|
| Rate for Payer: WPS Commercial |
$1,046.07
|
|
|
REMOTE CONTROL IRRIGATION IRD200
|
Facility
|
OP
|
$1,358.00
|
|
| Hospital Charge Code |
3884889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.45 |
| Max. Negotiated Rate |
$1,299.33 |
| Rate for Payer: Aetna Commercial |
$1,271.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.60
|
| Rate for Payer: Aetna Managed Medicare |
$395.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$918.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$706.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$677.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$748.53
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$1,299.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$790.36
|
| Rate for Payer: Health EOS Commercial |
$1,256.96
|
| Rate for Payer: HFN Commercial |
$1,299.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,059.24
|
| Rate for Payer: Multiplan Commercial |
$1,129.86
|
| Rate for Payer: NAPHCARE Commercial |
$847.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.33
|
| Rate for Payer: Quartz Beloit One Network |
$692.04
|
| Rate for Payer: Quartz Commercial |
$918.01
|
| Rate for Payer: Quartz Medicare Advantage |
$847.39
|
| Rate for Payer: The Alliance Commercial |
$706.16
|
| Rate for Payer: WEA Trust Commercial |
$776.78
|
| Rate for Payer: WPS Commercial |
$1,046.07
|
|
|
Remote Pacer Interogation
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 93296
|
| Hospital Charge Code |
3052489
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$407.60 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.66
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$407.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$287.98
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$332.28
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
Remote Pacer Interogation
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 93296
|
| Hospital Charge Code |
3052489
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$217.09 |
| Max. Negotiated Rate |
$407.60 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.81
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$407.60
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$265.82
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
REMOVAL FOREIGN BODY, GUM 41805
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
CPT 41805
|
| Hospital Charge Code |
3014620
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$848.86 |
| Rate for Payer: Aetna Commercial |
$305.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.37
|
| Rate for Payer: Aetna Managed Medicare |
$188.64
|
| Rate for Payer: Anthem Medicare Advantage |
$188.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$188.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$188.64
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$305.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.64
|
| Rate for Payer: Health EOS Commercial |
$292.44
|
| Rate for Payer: HFN Commercial |
$305.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$725.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$725.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$188.64
|
| Rate for Payer: Multiplan Commercial |
$257.09
|
| Rate for Payer: NAPHCARE Commercial |
$282.95
|
| Rate for Payer: Preferred Network Access Commercial |
$305.29
|
| Rate for Payer: Quartz Beloit One Network |
$141.40
|
| Rate for Payer: Quartz Commercial |
$183.18
|
| Rate for Payer: Quartz Medicare Advantage |
$188.64
|
| Rate for Payer: The Alliance Commercial |
$801.70
|
| Rate for Payer: United Healthcare Medicaid |
$45.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.64
|
| Rate for Payer: WEA Trust Commercial |
$176.75
|
| Rate for Payer: WPS Commercial |
$848.86
|
|
|
REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$13,956.63
|
|
|
Service Code
|
CPT 30310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,979.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,489.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,489.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,489.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,489.16
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,489.16
|
| Rate for Payer: The Alliance Commercial |
$13,956.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,489.16
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
|
|
REMOVAL HAND LESION SUBCUT 26115
|
Professional
|
Both
|
$1,548.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
3013940
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.30 |
| Max. Negotiated Rate |
$1,529.42 |
| Rate for Payer: Aetna Commercial |
$1,529.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,384.53
|
| Rate for Payer: Aetna Managed Medicare |
$308.83
|
| Rate for Payer: Anthem Medicare Advantage |
$308.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$308.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$308.83
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$1,529.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.83
|
| Rate for Payer: Health EOS Commercial |
$1,465.03
|
| Rate for Payer: HFN Commercial |
$1,529.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,150.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,150.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$308.83
|
| Rate for Payer: Multiplan Commercial |
$1,287.94
|
| Rate for Payer: NAPHCARE Commercial |
$463.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,529.42
|
| Rate for Payer: Quartz Beloit One Network |
$708.36
|
| Rate for Payer: Quartz Commercial |
$917.65
|
| Rate for Payer: Quartz Medicare Advantage |
$308.83
|
| Rate for Payer: The Alliance Commercial |
$1,312.52
|
| Rate for Payer: United Healthcare Medicaid |
$114.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$308.83
|
| Rate for Payer: WEA Trust Commercial |
$885.46
|
| Rate for Payer: WPS Commercial |
$1,389.73
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
|
|
Removal LVAD-IMPELLA
|
Facility
|
IP
|
$17,436.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
5128680
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,885.39 |
| Max. Negotiated Rate |
$16,682.76 |
| Rate for Payer: Aetna Commercial |
$16,320.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,594.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,610.72
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cigna Commercial |
$16,682.76
|
| Rate for Payer: Health EOS Commercial |
$16,138.76
|
| Rate for Payer: HFN Commercial |
$16,682.76
|
| Rate for Payer: Multiplan Commercial |
$14,506.75
|
| Rate for Payer: Preferred Network Access Commercial |
$16,682.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,885.39
|
| Rate for Payer: Quartz Commercial |
$10,880.06
|
| Rate for Payer: WEA Trust Commercial |
$9,973.39
|
| Rate for Payer: WPS Commercial |
$13,430.95
|
|
|
Removal LVAD-IMPELLA
|
Facility
|
OP
|
$17,436.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
5128680
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$603.70 |
| Max. Negotiated Rate |
$16,682.76 |
| Rate for Payer: Aetna Commercial |
$16,320.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,594.76
|
| Rate for Payer: Aetna Managed Medicare |
$5,077.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,786.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,066.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,704.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,610.72
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cigna Commercial |
$16,682.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$16,138.76
|
| Rate for Payer: HFN Commercial |
$16,682.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,600.08
|
| Rate for Payer: Multiplan Commercial |
$14,506.75
|
| Rate for Payer: NAPHCARE Commercial |
$10,880.06
|
| Rate for Payer: Preferred Network Access Commercial |
$16,682.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,885.39
|
| Rate for Payer: Quartz Commercial |
$11,786.74
|
| Rate for Payer: Quartz Medicare Advantage |
$10,880.06
|
| Rate for Payer: The Alliance Commercial |
$603.70
|
| Rate for Payer: WEA Trust Commercial |
$9,973.39
|
| Rate for Payer: WPS Commercial |
$13,430.95
|
|
|
REMOVAL OF ANAL FISSURE 46200
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
CPT 46200
|
| Hospital Charge Code |
3014826
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.72 |
| Max. Negotiated Rate |
$1,520.91 |
| Rate for Payer: Aetna Commercial |
$1,397.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,264.68
|
| Rate for Payer: Aetna Managed Medicare |
$337.98
|
| Rate for Payer: Anthem Medicare Advantage |
$337.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$337.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$337.98
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cigna Commercial |
$1,397.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.98
|
| Rate for Payer: Health EOS Commercial |
$1,338.21
|
| Rate for Payer: HFN Commercial |
$1,397.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,173.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,173.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$337.98
|
| Rate for Payer: Multiplan Commercial |
$1,176.45
|
| Rate for Payer: NAPHCARE Commercial |
$506.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.03
|
| Rate for Payer: Quartz Beloit One Network |
$647.05
|
| Rate for Payer: Quartz Commercial |
$838.22
|
| Rate for Payer: Quartz Medicare Advantage |
$337.98
|
| Rate for Payer: The Alliance Commercial |
$1,436.41
|
| Rate for Payer: United Healthcare Medicaid |
$217.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$337.98
|
| Rate for Payer: WEA Trust Commercial |
$808.81
|
| Rate for Payer: WPS Commercial |
$1,520.91
|
|
|
REMOVAL OF ANAL FISTULA 46270
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
CPT 46270
|
| Hospital Charge Code |
3014836
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,760.90 |
| Rate for Payer: Aetna Commercial |
$936.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.89
|
| Rate for Payer: Aetna Managed Medicare |
$391.31
|
| Rate for Payer: Anthem Medicare Advantage |
$391.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$391.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$391.31
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$936.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$391.31
|
| Rate for Payer: Health EOS Commercial |
$897.19
|
| Rate for Payer: HFN Commercial |
$936.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,383.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,383.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$391.31
|
| Rate for Payer: Multiplan Commercial |
$788.74
|
| Rate for Payer: NAPHCARE Commercial |
$586.97
|
| Rate for Payer: Preferred Network Access Commercial |
$936.62
|
| Rate for Payer: Quartz Beloit One Network |
$433.80
|
| Rate for Payer: Quartz Commercial |
$561.97
|
| Rate for Payer: Quartz Medicare Advantage |
$391.31
|
| Rate for Payer: The Alliance Commercial |
$1,663.07
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$391.31
|
| Rate for Payer: WEA Trust Commercial |
$542.26
|
| Rate for Payer: WPS Commercial |
$1,760.90
|
|
|
REMOVAL OF ANAL FISTULA 46275
|
Professional
|
Both
|
$2,002.00
|
|
|
Service Code
|
CPT 46275
|
| Hospital Charge Code |
3014837
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.21 |
| Max. Negotiated Rate |
$1,977.98 |
| Rate for Payer: Aetna Commercial |
$1,977.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,790.59
|
| Rate for Payer: Aetna Managed Medicare |
$409.21
|
| Rate for Payer: Anthem Medicare Advantage |
$409.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$409.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$409.21
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,977.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$626.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.21
|
| Rate for Payer: Health EOS Commercial |
$1,894.69
|
| Rate for Payer: HFN Commercial |
$1,977.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,462.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$409.21
|
| Rate for Payer: Multiplan Commercial |
$1,665.66
|
| Rate for Payer: NAPHCARE Commercial |
$613.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,977.98
|
| Rate for Payer: Quartz Beloit One Network |
$916.12
|
| Rate for Payer: Quartz Commercial |
$1,186.79
|
| Rate for Payer: Quartz Medicare Advantage |
$409.21
|
| Rate for Payer: The Alliance Commercial |
$1,739.14
|
| Rate for Payer: United Healthcare Medicaid |
$626.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$409.21
|
| Rate for Payer: WEA Trust Commercial |
$1,145.14
|
| Rate for Payer: WPS Commercial |
$1,841.44
|
|
|
REMOVAL OF ANAL FISTULA 46285
|
Professional
|
Both
|
$1,659.00
|
|
|
Service Code
|
CPT 46285
|
| Hospital Charge Code |
3014839
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,847.90 |
| Rate for Payer: Aetna Commercial |
$1,639.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,483.81
|
| Rate for Payer: Aetna Managed Medicare |
$410.64
|
| Rate for Payer: Anthem Medicare Advantage |
$410.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$410.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$410.64
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cigna Commercial |
$1,639.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.64
|
| Rate for Payer: Health EOS Commercial |
$1,570.08
|
| Rate for Payer: HFN Commercial |
$1,639.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,462.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$410.64
|
| Rate for Payer: Multiplan Commercial |
$1,380.29
|
| Rate for Payer: NAPHCARE Commercial |
$615.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,639.09
|
| Rate for Payer: Quartz Beloit One Network |
$759.16
|
| Rate for Payer: Quartz Commercial |
$983.46
|
| Rate for Payer: Quartz Medicare Advantage |
$410.64
|
| Rate for Payer: The Alliance Commercial |
$1,745.24
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$410.64
|
| Rate for Payer: WEA Trust Commercial |
$948.95
|
| Rate for Payer: WPS Commercial |
$1,847.90
|
|
|
Removal of Anal Fistula 4699946270
|
Professional
|
Both
|
$896.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
5424643
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$410.01 |
| Max. Negotiated Rate |
$885.25 |
| Rate for Payer: Aetna Commercial |
$885.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$885.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$465.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.10
|
| Rate for Payer: Health EOS Commercial |
$847.97
|
| Rate for Payer: HFN Commercial |
$885.25
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: Preferred Network Access Commercial |
$885.25
|
| Rate for Payer: Quartz Beloit One Network |
$410.01
|
| Rate for Payer: Quartz Commercial |
$531.15
|
| Rate for Payer: The Alliance Commercial |
$465.92
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
REMOVAL OF ANAL TAG 46220
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
3014828
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.88 |
| Max. Negotiated Rate |
$516.95 |
| Rate for Payer: Aetna Commercial |
$431.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$114.88
|
| Rate for Payer: Anthem Medicare Advantage |
$114.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.88
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$431.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.88
|
| Rate for Payer: Health EOS Commercial |
$413.58
|
| Rate for Payer: HFN Commercial |
$431.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$415.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$415.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.88
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$172.32
|
| Rate for Payer: Preferred Network Access Commercial |
$431.76
|
| Rate for Payer: Quartz Beloit One Network |
$199.97
|
| Rate for Payer: Quartz Commercial |
$259.05
|
| Rate for Payer: Quartz Medicare Advantage |
$114.88
|
| Rate for Payer: The Alliance Commercial |
$488.23
|
| Rate for Payer: United Healthcare Medicaid |
$181.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.88
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$516.95
|
|
|
REMOVAL OF ARM FOREIGN BODY 24201
|
Professional
|
Both
|
$1,276.00
|
|
|
Service Code
|
CPT 24201
|
| Hospital Charge Code |
3013818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.14 |
| Max. Negotiated Rate |
$1,689.06 |
| Rate for Payer: Aetna Commercial |
$1,260.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.25
|
| Rate for Payer: Aetna Managed Medicare |
$375.35
|
| Rate for Payer: Anthem Medicare Advantage |
$375.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$375.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$375.35
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,260.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.35
|
| Rate for Payer: Health EOS Commercial |
$1,207.61
|
| Rate for Payer: HFN Commercial |
$1,260.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,251.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,251.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$375.35
|
| Rate for Payer: Multiplan Commercial |
$1,061.63
|
| Rate for Payer: NAPHCARE Commercial |
$563.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,260.69
|
| Rate for Payer: Quartz Beloit One Network |
$583.90
|
| Rate for Payer: Quartz Commercial |
$756.41
|
| Rate for Payer: Quartz Medicare Advantage |
$375.35
|
| Rate for Payer: The Alliance Commercial |
$1,595.22
|
| Rate for Payer: United Healthcare Medicaid |
$97.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$375.35
|
| Rate for Payer: WEA Trust Commercial |
$729.87
|
| Rate for Payer: WPS Commercial |
$1,689.06
|
|
|
REMOVAL OF BONE FOR GRAFT 20900
|
Professional
|
Both
|
$963.00
|
|
|
Service Code
|
CPT 20900
|
| Hospital Charge Code |
3013713
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$951.44 |
| Rate for Payer: Aetna Commercial |
$951.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Aetna Managed Medicare |
$153.50
|
| Rate for Payer: Anthem Medicare Advantage |
$153.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$153.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$153.50
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$951.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.50
|
| Rate for Payer: Health EOS Commercial |
$911.38
|
| Rate for Payer: HFN Commercial |
$951.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$626.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$626.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$153.50
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: NAPHCARE Commercial |
$230.26
|
| Rate for Payer: Preferred Network Access Commercial |
$951.44
|
| Rate for Payer: Quartz Beloit One Network |
$440.67
|
| Rate for Payer: Quartz Commercial |
$570.87
|
| Rate for Payer: Quartz Medicare Advantage |
$153.50
|
| Rate for Payer: The Alliance Commercial |
$652.39
|
| Rate for Payer: United Healthcare Medicaid |
$206.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.50
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$690.77
|
|
|
REMOVAL OF BREAST LESION 19120
|
Professional
|
Both
|
$1,684.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
3013679
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$318.16 |
| Max. Negotiated Rate |
$1,719.01 |
| Rate for Payer: Aetna Commercial |
$1,663.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,506.17
|
| Rate for Payer: Aetna Managed Medicare |
$382.00
|
| Rate for Payer: Anthem Medicare Advantage |
$382.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$382.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$382.00
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,663.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$318.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.00
|
| Rate for Payer: Health EOS Commercial |
$1,593.74
|
| Rate for Payer: HFN Commercial |
$1,663.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,411.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$382.00
|
| Rate for Payer: Multiplan Commercial |
$1,401.09
|
| Rate for Payer: NAPHCARE Commercial |
$573.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.79
|
| Rate for Payer: Quartz Beloit One Network |
$770.60
|
| Rate for Payer: Quartz Commercial |
$998.28
|
| Rate for Payer: Quartz Medicare Advantage |
$382.00
|
| Rate for Payer: The Alliance Commercial |
$1,623.51
|
| Rate for Payer: United Healthcare Medicaid |
$318.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$382.00
|
| Rate for Payer: WEA Trust Commercial |
$963.25
|
| Rate for Payer: WPS Commercial |
$1,719.01
|
|
|
Removal of Breast Lesion 1912050
|
Professional
|
Both
|
$3,369.00
|
|
|
Service Code
|
CPT 19120 50
|
| Hospital Charge Code |
4217287
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$318.16 |
| Max. Negotiated Rate |
$3,328.57 |
| Rate for Payer: Aetna Commercial |
$3,328.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,328.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$318.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.26
|
| Rate for Payer: Health EOS Commercial |
$3,188.42
|
| Rate for Payer: HFN Commercial |
$3,328.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,411.54
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,328.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.65
|
| Rate for Payer: Quartz Commercial |
$1,997.14
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: United Healthcare Medicaid |
$318.16
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
REMOVAL OF BREAST TISSUE 19300
|
Professional
|
Both
|
$2,552.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
3013683
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$404.53 |
| Max. Negotiated Rate |
$2,521.38 |
| Rate for Payer: Aetna Commercial |
$2,521.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,282.51
|
| Rate for Payer: Aetna Managed Medicare |
$404.53
|
| Rate for Payer: Anthem Medicare Advantage |
$404.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$404.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$404.53
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cigna Commercial |
$2,521.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$405.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.53
|
| Rate for Payer: Health EOS Commercial |
$2,415.21
|
| Rate for Payer: HFN Commercial |
$2,521.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,463.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,463.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$404.53
|
| Rate for Payer: Multiplan Commercial |
$2,123.26
|
| Rate for Payer: NAPHCARE Commercial |
$606.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,521.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,167.80
|
| Rate for Payer: Quartz Commercial |
$1,512.83
|
| Rate for Payer: Quartz Medicare Advantage |
$404.53
|
| Rate for Payer: The Alliance Commercial |
$1,719.25
|
| Rate for Payer: United Healthcare Medicaid |
$405.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.53
|
| Rate for Payer: WEA Trust Commercial |
$1,459.74
|
| Rate for Payer: WPS Commercial |
$1,820.38
|
|
|
Removal of Breast Tissue 1930050
|
Professional
|
Both
|
$5,105.00
|
|
|
Service Code
|
CPT 19300 50
|
| Hospital Charge Code |
5250610
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$5,043.74 |
| Rate for Payer: Aetna Commercial |
$5,043.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,565.91
|
| Rate for Payer: Cash Price |
$1,531.50
|
| Rate for Payer: Cash Price |
$1,531.50
|
| Rate for Payer: Cash Price |
$1,531.50
|
| Rate for Payer: Cigna Commercial |
$5,043.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$405.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,185.52
|
| Rate for Payer: Health EOS Commercial |
$4,831.37
|
| Rate for Payer: HFN Commercial |
$5,043.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,463.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,463.82
|
| Rate for Payer: Multiplan Commercial |
$4,247.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,043.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,336.05
|
| Rate for Payer: Quartz Commercial |
$3,026.24
|
| Rate for Payer: The Alliance Commercial |
$2,654.60
|
| Rate for Payer: United Healthcare Medicaid |
$405.00
|
| Rate for Payer: WEA Trust Commercial |
$2,920.06
|
| Rate for Payer: WPS Commercial |
$3,932.38
|
|
|
Removal of Cast 29700
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
2572819
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.11 |
| Max. Negotiated Rate |
$129.43 |
| Rate for Payer: Aetna Commercial |
$129.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$28.74
|
| Rate for Payer: Anthem Medicare Advantage |
$28.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.74
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$129.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.74
|
| Rate for Payer: Health EOS Commercial |
$123.98
|
| Rate for Payer: HFN Commercial |
$129.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.74
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$43.10
|
| Rate for Payer: Preferred Network Access Commercial |
$129.43
|
| Rate for Payer: Quartz Beloit One Network |
$59.95
|
| Rate for Payer: Quartz Commercial |
$77.66
|
| Rate for Payer: Quartz Medicare Advantage |
$28.74
|
| Rate for Payer: The Alliance Commercial |
$122.12
|
| Rate for Payer: United Healthcare Medicaid |
$23.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$129.31
|
|
|
REMOVAL OF CONTRACEPTIVE CAP 11976
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
3013580
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.63 |
| Max. Negotiated Rate |
$625.40 |
| Rate for Payer: Aetna Commercial |
$625.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$566.16
|
| Rate for Payer: Aetna Managed Medicare |
$75.63
|
| Rate for Payer: Anthem Medicare Advantage |
$75.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.63
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cigna Commercial |
$625.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.63
|
| Rate for Payer: Health EOS Commercial |
$599.07
|
| Rate for Payer: HFN Commercial |
$625.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.63
|
| Rate for Payer: Multiplan Commercial |
$526.66
|
| Rate for Payer: NAPHCARE Commercial |
$113.44
|
| Rate for Payer: Preferred Network Access Commercial |
$625.40
|
| Rate for Payer: Quartz Beloit One Network |
$289.66
|
| Rate for Payer: Quartz Commercial |
$375.24
|
| Rate for Payer: Quartz Medicare Advantage |
$75.63
|
| Rate for Payer: The Alliance Commercial |
$321.42
|
| Rate for Payer: United Healthcare Medicaid |
$128.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.63
|
| Rate for Payer: WEA Trust Commercial |
$362.08
|
| Rate for Payer: WPS Commercial |
$340.33
|
|
|
Removal of Devitalized Tissue from Wound(s)
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
1188991
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.96 |
| Max. Negotiated Rate |
$292.64 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$164.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.58
|
| Rate for Payer: Health EOS Commercial |
$157.10
|
| Rate for Payer: HFN Commercial |
$164.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.64
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: Preferred Network Access Commercial |
$164.01
|
| Rate for Payer: Quartz Beloit One Network |
$75.96
|
| Rate for Payer: Quartz Commercial |
$98.40
|
| Rate for Payer: The Alliance Commercial |
$86.32
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
