|
REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE 40804
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
6209970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$507.17 |
| Rate for Payer: Aetna Commercial |
$464.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Aetna Managed Medicare |
$112.70
|
| Rate for Payer: Anthem Medicare Advantage |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.70
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$464.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.70
|
| Rate for Payer: Health EOS Commercial |
$444.81
|
| Rate for Payer: HFN Commercial |
$464.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$400.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.70
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: NAPHCARE Commercial |
$169.06
|
| Rate for Payer: Preferred Network Access Commercial |
$464.36
|
| Rate for Payer: Quartz Beloit One Network |
$215.07
|
| Rate for Payer: Quartz Commercial |
$278.62
|
| Rate for Payer: Quartz Medicare Advantage |
$112.70
|
| Rate for Payer: The Alliance Commercial |
$479.00
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.70
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$507.17
|
|
|
REMOVAL OF EYE LESION 65420
|
Professional
|
Both
|
$1,587.00
|
|
|
Service Code
|
CPT 65420
|
| Hospital Charge Code |
3015222
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$331.74 |
| Max. Negotiated Rate |
$1,567.96 |
| Rate for Payer: Aetna Commercial |
$1,567.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,419.41
|
| Rate for Payer: Aetna Managed Medicare |
$331.74
|
| Rate for Payer: Anthem Medicare Advantage |
$331.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$331.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$331.74
|
| Rate for Payer: Cash Price |
$476.10
|
| Rate for Payer: Cash Price |
$476.10
|
| Rate for Payer: Cash Price |
$476.10
|
| Rate for Payer: Cigna Commercial |
$1,567.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$361.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.74
|
| Rate for Payer: Health EOS Commercial |
$1,501.94
|
| Rate for Payer: HFN Commercial |
$1,567.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,325.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,325.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$331.74
|
| Rate for Payer: Multiplan Commercial |
$1,320.38
|
| Rate for Payer: NAPHCARE Commercial |
$497.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,567.96
|
| Rate for Payer: Quartz Beloit One Network |
$726.21
|
| Rate for Payer: Quartz Commercial |
$940.77
|
| Rate for Payer: Quartz Medicare Advantage |
$331.74
|
| Rate for Payer: The Alliance Commercial |
$1,409.89
|
| Rate for Payer: United Healthcare Medicaid |
$361.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$331.74
|
| Rate for Payer: WEA Trust Commercial |
$907.76
|
| Rate for Payer: WPS Commercial |
$1,492.83
|
|
|
Removal Of Fecal Impaction Or Foreign Body
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
1190852
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$133.27 |
| Max. Negotiated Rate |
$1,318.98 |
| Rate for Payer: Aetna Commercial |
$1,318.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,194.02
|
| Rate for Payer: Aetna Managed Medicare |
$221.49
|
| Rate for Payer: Anthem Medicare Advantage |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$221.49
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna Commercial |
$1,318.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.49
|
| Rate for Payer: Health EOS Commercial |
$1,263.44
|
| Rate for Payer: HFN Commercial |
$1,318.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$801.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$801.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$221.49
|
| Rate for Payer: Multiplan Commercial |
$1,110.72
|
| Rate for Payer: NAPHCARE Commercial |
$332.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,318.98
|
| Rate for Payer: Quartz Beloit One Network |
$610.90
|
| Rate for Payer: Quartz Commercial |
$791.39
|
| Rate for Payer: Quartz Medicare Advantage |
$221.49
|
| Rate for Payer: The Alliance Commercial |
$941.33
|
| Rate for Payer: United Healthcare Medicaid |
$133.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.49
|
| Rate for Payer: WEA Trust Commercial |
$763.62
|
| Rate for Payer: WPS Commercial |
$996.70
|
|
|
Removal of Fecal Impaction Or Foreign Body 45999-45915
|
Professional
|
Both
|
$1,334.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
6173584
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$133.27 |
| Max. Negotiated Rate |
$1,317.99 |
| Rate for Payer: Aetna Commercial |
$1,317.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,193.13
|
| Rate for Payer: Aetna Managed Medicare |
$221.49
|
| Rate for Payer: Anthem Medicare Advantage |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$221.49
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$1,317.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.49
|
| Rate for Payer: Health EOS Commercial |
$1,262.50
|
| Rate for Payer: HFN Commercial |
$1,317.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$801.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$801.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$221.49
|
| Rate for Payer: Multiplan Commercial |
$1,109.89
|
| Rate for Payer: NAPHCARE Commercial |
$332.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,317.99
|
| Rate for Payer: Quartz Beloit One Network |
$610.44
|
| Rate for Payer: Quartz Commercial |
$790.80
|
| Rate for Payer: Quartz Medicare Advantage |
$221.49
|
| Rate for Payer: The Alliance Commercial |
$941.33
|
| Rate for Payer: United Healthcare Medicaid |
$133.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.49
|
| Rate for Payer: WEA Trust Commercial |
$763.05
|
| Rate for Payer: WPS Commercial |
$996.70
|
|
|
REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
OP
|
$5,037.34
|
|
|
Service Code
|
CPT 45915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.34 |
| Max. Negotiated Rate |
$5,037.34 |
| Rate for Payer: Aetna Managed Medicare |
$1,259.34
|
| 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 |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,259.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,259.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,259.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,684.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,259.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,259.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,259.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,259.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,259.34
|
| Rate for Payer: The Alliance Commercial |
$5,037.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,259.34
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,259.34
|
|
|
REMOVAL OF FOOT FOREIGN BODY 28190
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
3014213
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$613.55 |
| Rate for Payer: Aetna Commercial |
$613.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.42
|
| Rate for Payer: Aetna Managed Medicare |
$125.24
|
| Rate for Payer: Anthem Medicare Advantage |
$125.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.24
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$613.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.24
|
| Rate for Payer: Health EOS Commercial |
$587.71
|
| Rate for Payer: HFN Commercial |
$613.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$467.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$467.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.24
|
| Rate for Payer: Multiplan Commercial |
$516.67
|
| Rate for Payer: NAPHCARE Commercial |
$187.86
|
| Rate for Payer: Preferred Network Access Commercial |
$613.55
|
| Rate for Payer: Quartz Beloit One Network |
$284.17
|
| Rate for Payer: Quartz Commercial |
$368.13
|
| Rate for Payer: Quartz Medicare Advantage |
$125.24
|
| Rate for Payer: The Alliance Commercial |
$532.26
|
| Rate for Payer: United Healthcare Medicaid |
$43.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.24
|
| Rate for Payer: WEA Trust Commercial |
$355.21
|
| Rate for Payer: WPS Commercial |
$563.57
|
|
|
REMOVAL OF FOOT FOREIGN BODY 28192
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
3014214
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.28 |
| Max. Negotiated Rate |
$1,300.15 |
| Rate for Payer: Aetna Commercial |
$481.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.57
|
| Rate for Payer: Aetna Managed Medicare |
$288.92
|
| Rate for Payer: Anthem Medicare Advantage |
$288.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$288.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$288.92
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.92
|
| Rate for Payer: Health EOS Commercial |
$460.90
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,095.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,095.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$288.92
|
| Rate for Payer: Multiplan Commercial |
$405.18
|
| Rate for Payer: NAPHCARE Commercial |
$433.38
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$222.85
|
| Rate for Payer: Quartz Commercial |
$288.69
|
| Rate for Payer: Quartz Medicare Advantage |
$288.92
|
| Rate for Payer: The Alliance Commercial |
$1,227.92
|
| Rate for Payer: United Healthcare Medicaid |
$194.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.92
|
| Rate for Payer: WEA Trust Commercial |
$278.56
|
| Rate for Payer: WPS Commercial |
$1,300.15
|
|
|
REMOVAL OF FOOT FOREIGN BODY 28193
|
Professional
|
Both
|
$1,746.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
3014215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.65 |
| Max. Negotiated Rate |
$1,725.05 |
| Rate for Payer: Aetna Commercial |
$1,725.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,561.62
|
| Rate for Payer: Aetna Managed Medicare |
$336.19
|
| Rate for Payer: Anthem Medicare Advantage |
$336.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$336.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$336.19
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$1,725.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$218.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.19
|
| Rate for Payer: Health EOS Commercial |
$1,652.41
|
| Rate for Payer: HFN Commercial |
$1,725.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,294.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,294.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$336.19
|
| Rate for Payer: Multiplan Commercial |
$1,452.67
|
| Rate for Payer: NAPHCARE Commercial |
$504.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.05
|
| Rate for Payer: Quartz Beloit One Network |
$798.97
|
| Rate for Payer: Quartz Commercial |
$1,035.03
|
| Rate for Payer: Quartz Medicare Advantage |
$336.19
|
| Rate for Payer: The Alliance Commercial |
$1,428.81
|
| Rate for Payer: United Healthcare Medicaid |
$218.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.19
|
| Rate for Payer: WEA Trust Commercial |
$998.71
|
| Rate for Payer: WPS Commercial |
$1,512.86
|
|
|
REMOVAL OF FOOT LESION 28080
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
3014194
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$1,632.99 |
| Rate for Payer: Aetna Commercial |
$1,406.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Aetna Managed Medicare |
$362.89
|
| Rate for Payer: Anthem Medicare Advantage |
$362.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$362.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$362.89
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,406.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$272.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$362.89
|
| Rate for Payer: Health EOS Commercial |
$1,347.67
|
| Rate for Payer: HFN Commercial |
$1,406.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,308.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,308.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$362.89
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: NAPHCARE Commercial |
$544.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,406.91
|
| Rate for Payer: Quartz Beloit One Network |
$651.62
|
| Rate for Payer: Quartz Commercial |
$844.15
|
| Rate for Payer: Quartz Medicare Advantage |
$362.89
|
| Rate for Payer: The Alliance Commercial |
$1,542.27
|
| Rate for Payer: United Healthcare Medicaid |
$272.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.89
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,632.99
|
|
|
Removal of Foot Lesion 2808050
|
Professional
|
Both
|
$2,844.00
|
|
|
Service Code
|
CPT 28080 50
|
| Hospital Charge Code |
3292170
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$2,809.87 |
| Rate for Payer: Aetna Commercial |
$2,809.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,543.67
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,809.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$272.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,774.66
|
| Rate for Payer: Health EOS Commercial |
$2,691.56
|
| Rate for Payer: HFN Commercial |
$2,809.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,308.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,308.46
|
| Rate for Payer: Multiplan Commercial |
$2,366.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,809.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,301.41
|
| Rate for Payer: Quartz Commercial |
$1,685.92
|
| Rate for Payer: The Alliance Commercial |
$1,478.88
|
| Rate for Payer: United Healthcare Medicaid |
$272.16
|
| Rate for Payer: WEA Trust Commercial |
$1,626.77
|
| Rate for Payer: WPS Commercial |
$2,190.73
|
|
|
REMOVAL OF FOOT LESION 28090
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
3014196
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$289.15 |
| Max. Negotiated Rate |
$1,448.41 |
| Rate for Payer: Aetna Commercial |
$1,448.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.19
|
| Rate for Payer: Aetna Managed Medicare |
$289.15
|
| Rate for Payer: Anthem Medicare Advantage |
$289.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$289.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$289.15
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,448.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$373.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.15
|
| Rate for Payer: Health EOS Commercial |
$1,387.42
|
| Rate for Payer: HFN Commercial |
$1,448.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,076.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,076.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$289.15
|
| Rate for Payer: Multiplan Commercial |
$1,219.71
|
| Rate for Payer: NAPHCARE Commercial |
$433.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,448.41
|
| Rate for Payer: Quartz Beloit One Network |
$670.84
|
| Rate for Payer: Quartz Commercial |
$869.04
|
| Rate for Payer: Quartz Medicare Advantage |
$289.15
|
| Rate for Payer: The Alliance Commercial |
$1,228.89
|
| Rate for Payer: United Healthcare Medicaid |
$373.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.15
|
| Rate for Payer: WEA Trust Commercial |
$838.55
|
| Rate for Payer: WPS Commercial |
$1,301.18
|
|
|
REMOVAL OF FOOT LESION 28104
|
Professional
|
Both
|
$2,130.00
|
|
|
Service Code
|
CPT 28104
|
| Hospital Charge Code |
3014198
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$331.14 |
| Max. Negotiated Rate |
$2,104.44 |
| Rate for Payer: Aetna Commercial |
$2,104.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.07
|
| Rate for Payer: Aetna Managed Medicare |
$331.14
|
| Rate for Payer: Anthem Medicare Advantage |
$331.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$331.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$331.14
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna Commercial |
$2,104.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.14
|
| Rate for Payer: Health EOS Commercial |
$2,015.83
|
| Rate for Payer: HFN Commercial |
$2,104.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,239.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,239.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$331.14
|
| Rate for Payer: Multiplan Commercial |
$1,772.16
|
| Rate for Payer: NAPHCARE Commercial |
$496.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.44
|
| Rate for Payer: Quartz Beloit One Network |
$974.69
|
| Rate for Payer: Quartz Commercial |
$1,262.66
|
| Rate for Payer: Quartz Medicare Advantage |
$331.14
|
| Rate for Payer: The Alliance Commercial |
$1,407.33
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$331.14
|
| Rate for Payer: WEA Trust Commercial |
$1,218.36
|
| Rate for Payer: WPS Commercial |
$1,490.11
|
|
|
REMOVAL OF FOREIGN BODY 27372
|
Professional
|
Both
|
$2,046.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
3014063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.27 |
| Max. Negotiated Rate |
$2,021.45 |
| Rate for Payer: Aetna Commercial |
$2,021.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,829.94
|
| Rate for Payer: Aetna Managed Medicare |
$373.27
|
| Rate for Payer: Anthem Medicare Advantage |
$373.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$373.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$373.27
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$2,021.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.27
|
| Rate for Payer: Health EOS Commercial |
$1,936.33
|
| Rate for Payer: HFN Commercial |
$2,021.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,381.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,381.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$373.27
|
| Rate for Payer: Multiplan Commercial |
$1,702.27
|
| Rate for Payer: NAPHCARE Commercial |
$559.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,021.45
|
| Rate for Payer: Quartz Beloit One Network |
$936.25
|
| Rate for Payer: Quartz Commercial |
$1,212.87
|
| Rate for Payer: Quartz Medicare Advantage |
$373.27
|
| Rate for Payer: The Alliance Commercial |
$1,586.38
|
| Rate for Payer: United Healthcare Medicaid |
$163.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.27
|
| Rate for Payer: WEA Trust Commercial |
$1,170.31
|
| Rate for Payer: WPS Commercial |
$1,679.70
|
|
|
Removal of Foreign Body: Conjunctival Imbedded
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
1188894
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$393.22 |
| Rate for Payer: Aetna Commercial |
$393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.97
|
| Rate for Payer: Aetna Managed Medicare |
$30.13
|
| Rate for Payer: Anthem Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.13
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$393.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.13
|
| Rate for Payer: Health EOS Commercial |
$376.67
|
| Rate for Payer: HFN Commercial |
$393.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.13
|
| Rate for Payer: Multiplan Commercial |
$331.14
|
| Rate for Payer: NAPHCARE Commercial |
$45.19
|
| Rate for Payer: Preferred Network Access Commercial |
$393.22
|
| Rate for Payer: Quartz Beloit One Network |
$182.12
|
| Rate for Payer: Quartz Commercial |
$235.93
|
| Rate for Payer: Quartz Medicare Advantage |
$30.13
|
| Rate for Payer: The Alliance Commercial |
$128.05
|
| Rate for Payer: United Healthcare Medicaid |
$49.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.13
|
| Rate for Payer: WEA Trust Commercial |
$227.66
|
| Rate for Payer: WPS Commercial |
$135.58
|
|
|
Removal of Foreign Body: Cornea
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
1188892
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$403.10 |
| Rate for Payer: Aetna Commercial |
$403.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.92
|
| Rate for Payer: Aetna Managed Medicare |
$41.89
|
| Rate for Payer: Anthem Medicare Advantage |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.89
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna Commercial |
$403.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.89
|
| Rate for Payer: Health EOS Commercial |
$386.13
|
| Rate for Payer: HFN Commercial |
$403.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.89
|
| Rate for Payer: Multiplan Commercial |
$339.46
|
| Rate for Payer: NAPHCARE Commercial |
$62.84
|
| Rate for Payer: Preferred Network Access Commercial |
$403.10
|
| Rate for Payer: Quartz Beloit One Network |
$186.70
|
| Rate for Payer: Quartz Commercial |
$241.86
|
| Rate for Payer: Quartz Medicare Advantage |
$41.89
|
| Rate for Payer: The Alliance Commercial |
$178.04
|
| Rate for Payer: United Healthcare Medicaid |
$49.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.89
|
| Rate for Payer: WEA Trust Commercial |
$233.38
|
| Rate for Payer: WPS Commercial |
$188.51
|
|
|
Removal of Foreign Body: External Eye Superficial
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
1188893
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$249.96 |
| Rate for Payer: Aetna Commercial |
$249.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.28
|
| Rate for Payer: Aetna Managed Medicare |
$24.54
|
| Rate for Payer: Anthem Medicare Advantage |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.54
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$249.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.54
|
| Rate for Payer: Health EOS Commercial |
$239.44
|
| Rate for Payer: HFN Commercial |
$249.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.54
|
| Rate for Payer: Multiplan Commercial |
$210.50
|
| Rate for Payer: NAPHCARE Commercial |
$36.82
|
| Rate for Payer: Preferred Network Access Commercial |
$249.96
|
| Rate for Payer: Quartz Beloit One Network |
$115.77
|
| Rate for Payer: Quartz Commercial |
$149.98
|
| Rate for Payer: Quartz Medicare Advantage |
$24.54
|
| Rate for Payer: The Alliance Commercial |
$104.31
|
| Rate for Payer: United Healthcare Medicaid |
$35.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.54
|
| Rate for Payer: WEA Trust Commercial |
$144.72
|
| Rate for Payer: WPS Commercial |
$110.45
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; COMPLICATED
|
Facility
|
OP
|
$8,107.14
|
|
|
Service Code
|
CPT 28193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$8,107.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| 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 |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; DEEP
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 28192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| 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 |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
Removal of Foreign Body from External Auditory Canal
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
1152799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.21 |
| Max. Negotiated Rate |
$394.21 |
| Rate for Payer: Aetna Commercial |
$394.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Aetna Managed Medicare |
$40.21
|
| Rate for Payer: Anthem Medicare Advantage |
$40.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.21
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$394.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.21
|
| Rate for Payer: Health EOS Commercial |
$377.61
|
| Rate for Payer: HFN Commercial |
$394.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.21
|
| Rate for Payer: Multiplan Commercial |
$331.97
|
| Rate for Payer: NAPHCARE Commercial |
$60.31
|
| Rate for Payer: Preferred Network Access Commercial |
$394.21
|
| Rate for Payer: Quartz Beloit One Network |
$182.58
|
| Rate for Payer: Quartz Commercial |
$236.53
|
| Rate for Payer: Quartz Medicare Advantage |
$40.21
|
| Rate for Payer: The Alliance Commercial |
$170.88
|
| Rate for Payer: United Healthcare Medicaid |
$47.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.21
|
| Rate for Payer: WEA Trust Commercial |
$228.23
|
| Rate for Payer: WPS Commercial |
$180.93
|
|
|
Removal of foreign body from external auditory canal 6920050
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
CPT 69200 50
|
| Hospital Charge Code |
5313690
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.54 |
| Max. Negotiated Rate |
$634.30 |
| Rate for Payer: Aetna Commercial |
$634.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$634.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$400.61
|
| Rate for Payer: Health EOS Commercial |
$607.59
|
| Rate for Payer: HFN Commercial |
$634.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.94
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: Preferred Network Access Commercial |
$634.30
|
| Rate for Payer: Quartz Beloit One Network |
$293.78
|
| Rate for Payer: Quartz Commercial |
$380.58
|
| Rate for Payer: The Alliance Commercial |
$333.84
|
| Rate for Payer: United Healthcare Medicaid |
$47.54
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: WPS Commercial |
$494.53
|
|
|
Removal of foreign body in muscle or tendon; simple
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
1190879
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$621.18 |
| Rate for Payer: Aetna Commercial |
$501.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.36
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Medicare Advantage |
$138.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$138.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$138.04
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$501.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.04
|
| Rate for Payer: Health EOS Commercial |
$480.77
|
| Rate for Payer: HFN Commercial |
$501.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$513.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$513.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$138.04
|
| Rate for Payer: Multiplan Commercial |
$422.66
|
| Rate for Payer: NAPHCARE Commercial |
$207.06
|
| Rate for Payer: Preferred Network Access Commercial |
$501.90
|
| Rate for Payer: Quartz Beloit One Network |
$232.46
|
| Rate for Payer: Quartz Commercial |
$301.14
|
| Rate for Payer: Quartz Medicare Advantage |
$138.04
|
| Rate for Payer: The Alliance Commercial |
$586.67
|
| Rate for Payer: United Healthcare Medicaid |
$64.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.04
|
| Rate for Payer: WEA Trust Commercial |
$290.58
|
| Rate for Payer: WPS Commercial |
$621.18
|
|
|
Removal of Foreign Body; Intranasal
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
1152803
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$508.86 |
| Rate for Payer: Aetna Commercial |
$388.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Aetna Managed Medicare |
$113.08
|
| Rate for Payer: Anthem Medicare Advantage |
$113.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.08
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$388.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.08
|
| Rate for Payer: Health EOS Commercial |
$371.94
|
| Rate for Payer: HFN Commercial |
$388.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$422.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.08
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: NAPHCARE Commercial |
$169.62
|
| Rate for Payer: Preferred Network Access Commercial |
$388.28
|
| Rate for Payer: Quartz Beloit One Network |
$179.84
|
| Rate for Payer: Quartz Commercial |
$232.97
|
| Rate for Payer: Quartz Medicare Advantage |
$113.08
|
| Rate for Payer: The Alliance Commercial |
$480.59
|
| Rate for Payer: United Healthcare Medicaid |
$66.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.08
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
REMOVAL OF HEEL BONE 28118
|
Professional
|
Both
|
$1,827.00
|
|
|
Service Code
|
CPT 28118
|
| Hospital Charge Code |
3014204
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$1,805.08 |
| Rate for Payer: Aetna Commercial |
$1,805.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,634.07
|
| Rate for Payer: Aetna Managed Medicare |
$393.63
|
| Rate for Payer: Anthem Medicare Advantage |
$393.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$393.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$393.63
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cigna Commercial |
$1,805.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.63
|
| Rate for Payer: Health EOS Commercial |
$1,729.07
|
| Rate for Payer: HFN Commercial |
$1,805.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,462.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$393.63
|
| Rate for Payer: Multiplan Commercial |
$1,520.06
|
| Rate for Payer: NAPHCARE Commercial |
$590.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,805.08
|
| Rate for Payer: Quartz Beloit One Network |
$836.04
|
| Rate for Payer: Quartz Commercial |
$1,083.05
|
| Rate for Payer: Quartz Medicare Advantage |
$393.63
|
| Rate for Payer: The Alliance Commercial |
$1,672.93
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.63
|
| Rate for Payer: WEA Trust Commercial |
$1,045.04
|
| Rate for Payer: WPS Commercial |
$1,771.33
|
|
|
Removal of Heel Bone 2811822
|
Professional
|
Both
|
$2,003.00
|
|
|
Service Code
|
CPT 28118 22
|
| Hospital Charge Code |
4592949
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$1,978.96 |
| Rate for Payer: Aetna Commercial |
$1,978.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,791.48
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cigna Commercial |
$1,978.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,249.87
|
| Rate for Payer: Health EOS Commercial |
$1,895.64
|
| Rate for Payer: HFN Commercial |
$1,978.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,462.82
|
| Rate for Payer: Multiplan Commercial |
$1,666.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,978.96
|
| Rate for Payer: Quartz Beloit One Network |
$916.57
|
| Rate for Payer: Quartz Commercial |
$1,187.38
|
| Rate for Payer: The Alliance Commercial |
$1,041.56
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: WEA Trust Commercial |
$1,145.72
|
| Rate for Payer: WPS Commercial |
$1,542.91
|
|
|
REMOVAL OF HEEL SPUR 28119
|
Professional
|
Both
|
$2,078.00
|
|
|
Service Code
|
CPT 28119
|
| Hospital Charge Code |
3014205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$339.34 |
| Max. Negotiated Rate |
$2,053.06 |
| Rate for Payer: Aetna Commercial |
$2,053.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,858.56
|
| Rate for Payer: Aetna Managed Medicare |
$339.34
|
| Rate for Payer: Anthem Medicare Advantage |
$339.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$339.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$339.34
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cigna Commercial |
$2,053.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.34
|
| Rate for Payer: Health EOS Commercial |
$1,966.62
|
| Rate for Payer: HFN Commercial |
$2,053.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,269.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,269.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$339.34
|
| Rate for Payer: Multiplan Commercial |
$1,728.90
|
| Rate for Payer: NAPHCARE Commercial |
$509.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.06
|
| Rate for Payer: Quartz Beloit One Network |
$950.89
|
| Rate for Payer: Quartz Commercial |
$1,231.84
|
| Rate for Payer: Quartz Medicare Advantage |
$339.34
|
| Rate for Payer: The Alliance Commercial |
$1,442.20
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.34
|
| Rate for Payer: WEA Trust Commercial |
$1,188.62
|
| Rate for Payer: WPS Commercial |
$1,527.04
|
|
